title: Combination of GM-CSF With Fludarabine-Containing Regimens in Chronic Lymphocytic Leukemia and Indolent Non-Hodgkin Lymphoma.
abstract: BACKGROUND
  Granulocyte-monocyte colony stimulating factor (GM-CSF) is a hematopoietic cytokine with immunomodulatory activity that has preclinical evidence for enhancement of antitumor immunity when administered in combination with chemotherapy. We evaluated the utility of GM-CSF with chemoimmunotherapy in patients with indolent non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) in a pilot study.
  
  
  METHODS
  Patients with previously untreated, relapsed, or refractory indolent NHL or CLL were treated with GM-CSF, rituximab, fludarabine, and cyclophosphamide or mitoxantrone for a maximum of 6 cycles.
  
  
  RESULTS
  Sixteen patients were enrolled, including 1 patient who did not receive study therapy. Of the 15 remaining patients, 6 received cyclophosphamide and 9 received mitoxantrone in combination with fludarabine, rituximab, and GM-CSF. The overall response rate for all patients was 87%. Nine patients have subsequently had relapse of their disease, and 6 remained in remission at last study contact. There were no toxic deaths during the study.
  
  
  CONCLUSIONS
  GM-CSF-based chemoimmunotherapy was well-tolerated and resulted in a high response rate and warrants evaluation in larger studies.
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Jonathon B
authors: JB
authors: Cohen
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Silvana
authors: S
authors: Bucur
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Elliott F
authors: EF
authors: Winton
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Rajni
authors: R
authors: Sinha
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Leonard T
authors: LT
authors: Heffner
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Nassoma
authors: N
authors: King
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Sagar
authors: S
authors: Lonial
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Amelia A
authors: AA
authors: Langston
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Edmund K
authors: EK
authors: Waller
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Amanda
authors: A
authors: Hutchison-Rzepka
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Amanda
authors: A
authors: Colbert
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA.
authors: Mary Jo
authors: MJ
authors: Lechowicz
authors: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, GA. Electronic address: crflowe@emory.edu.
authors: Christopher R
authors: CR
authors: Flowers
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D000069283:Rituximab / Q000627:therapeutic use; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D018906:Antineoplastic Agents, Alkylating; D000069283:Rituximab; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine
keywords: Chemoimmunotherapy; Follicular lymphoma; Immunomodulation; Immunotherapy; Pilot study