Hematopoietic growth factors in acute myeloid leukemia: supportive and priming effects.

Hematopoietic growth factors (GFs) are administered to patients who have acute myeloid leukemia (AML) in order to overcome two limitations of chemotherapy: (I) myelotoxicity, and (2) the chemoresistance of minimal residual disease. GFs have been used after chemotherapy in 11 clinical studies, 8 on older age or otherwise high-risk AML. The GFs used were granulocyte-macrophage colony-stimulating factor (GM-CSF) in 7, G-CSF in three and macrophage-CSF in one of the studies.

The role of GM-CSF in the treatment of acute myeloid leukemia.

After a first study showed that GM-CSF following chemotherapy effectively accelerated neutrophil recovery and reduced early mortality in high risk patients with AML, a second study was begun in which GM-CSF was applied preceding chemotherapy and continuing until neutrophil recovery in the initial 5 chemotherapy courses for patients with newly diagnosed AML. The CR rate in patients of 16-75 (median 50) years was 75% in GM-CSF patients and 84% in controls. GM-CSF patients showed a trend to more frequent rapid blast clearance and fewer persistent leukemias and a significantly superior remission duration as of this update two-and-a-half years after the study started.

In vitro and in vivo effects of rh GM-CSF in acute myeloid leukemia (AML).

70% of patients with newly diagnosed and 50% of patients with relapsed acute myeloid leukemia (AML) can achieve a complete remission with intensive chemotherapy. However, the treatment-associated mortality can be as high as 30% increasing with age, previous chemotherapy and intensity of chemotherapy. GM-CSF was first applied in 36 patients with high risk AML after chemotherapy to reduce the time of critical neutropenia.

Treatment of advanced chronic lymphocytic leukemia by fludarabine. Results of a clinical phase-II study.

In a clinical phase-II study fludarabine phosphate was given to 20 patients with advanced chronic lymphocytic leukemia who had failed on prior conventional therapy. Fludarabine was administered at a dose of 25 mg/m2/d for 5 days. Treatment cycles were repeated every 4 weeks until maximal response, followed by two cycles for consolidation.