Effect of granulocyte colony-stimulating factor on outcomes in patients with non-M3 acute myelogenous leukemia treated with anthracycline-based induction (7+3 regimen) chemotherapies

Leuk Res. 2017 Jun:57:1-8. doi: 10.1016/j.leukres.2017.02.003. Epub 2017 Feb 8.

Abstract

We analyzed the effects of granulocyte colony-stimulating factor (G-CSF) on outcomes in 315 anthracycline-based induction chemotherapy-treated patients with non-M3 acute myelogenous leukemia (AML). Patients were classified as follows: no G-CSF administration during induction (no G-CSF group; 112 patients); administration immediately upon neutropenia onset (absolute neutrophil counts (ANC)<1000/μL), but before febrile neutropenia (preemptive group; 74 patients); and administration following febrile neutropenia development (therapeutic group; 129 patients). G-CSF users had a shorter time to ANC recovery than the no G-CSF group (p<0.001). The chemotherapy-induced febrile neutropenia (CIFN) duration was significantly shorter in the preemptive group than in other groups (p<0.001). The incidence of CIFN was not significantly different between preemptive and non-G-CSF users (84.8% versus 82.4%). Preemptive G-CSF administration modestly improved treatment-related mortality (TRM), compared with no G-CSF administration (p=0.076 in multivariate analysis). G-CSF administration did not affect relapse-free or overall survivals or the cumulative relapse incidence among the groups. In conclusion, preemptive G-CSF administration reduced CIFN duration and modestly improved TRM without affecting chemotherapy outcomes. These effects were not observed in the therapeutic group; therefore, initiation of G-CSF during induction therapy before the development of febrile neutropenia may be desirable.

Keywords: Acute myelogenous leukemia; Granulocyte colony-stimulating factor; Neutropenia; Treatment-related mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anthracyclines / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Chemotherapy-Induced Febrile Neutropenia
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Daunorubicin / administration & dosage
  • Female
  • Granulocyte Colony-Stimulating Factor / administration & dosage*
  • Humans
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / mortality
  • Male
  • Mercaptopurine / administration & dosage
  • Middle Aged
  • Mortality
  • Remission Induction / methods
  • Republic of Korea
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Anthracyclines
  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Cyclophosphamide
  • Mercaptopurine
  • Daunorubicin

Supplementary concepts

  • 7+3 protocol