Granulocyte-macrophage colony-stimulating factor (GM-CSF) priming with successive concomitant low-dose Ara-C for elderly patients with secondary/refractory acute myeloid leukemia or advanced myelodysplastic syndrome.

Abstract

Patients with advanced MDS and secondary AML respond poorly to chemotherapy. Granulocyte-macrophage colony-stimulating factor (GM-CSF) can stimulate proliferation of leukemic blasts and sensitize these cells to the cytotoxic effects of S-phase-specific drugs. This is the first report of safety and efficacy of GM-CSF prior to and during cytarabine in a low-dose, intermittent regimen for elderly patients with poor risk acute myelogenous leukemia or myelodysplastic syndrome. Twenty patients, age 68 to 86 years, each received 250 microg/m2 of GM-CSF (Sargramostatin; Immunex, Seattle, WA, USA) subcutaneously (s.c.) or intravenously (i.v.) for 3 days followed by GM-CSF at the same dose and cytarabine 100 mg/m2 i.v. for 3 days. GM-CSF and cytarabine were both administered for 3 days during weeks 2 and 3 followed by a 3-week rest period. Rates of CR and PR were 20% and 40%, respectively. These included clinically significant resolution of cytopenias and transfusion requirements. Many of the responding patients had been heavily pretreated prior to enrollment. One- and 2-year survival estimates are 44% and 19%, respectively. Myelosuppression was the most significant toxicity. Our findings suggest that this novel combination of GM-CSF with sequential and concomitant low-dose cytarabine can benefit patients with poor risk myeloid malignancies.

• Authors: H A Rossi, J O'Donnell, F Sarcinelli, F M Stewart, P J Quesenberry, P S Becker
• Journal: Leukemia (Leukemia) Vol. 16 Issue 3 Pg. 310-5 (Mar 2002) ISSN: 0887-6924 [Print] England
• PMID: 11896533 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimetabolites, Antineoplastic
• Cytarabine
• Granulocyte-Macrophage Colony-Stimulating Factor

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Antimetabolites, Antineoplastic (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cytarabine (administration & dosage)
• Female
• Granulocyte-Macrophage Colony-Stimulating Factor (administration & dosage)
• Humans
• Leukemia, Myeloid (drug therapy, mortality, pathology)
• Male
• Middle Aged
• Neutropenia (chemically induced)
• Survival Rate
• Thrombocytopenia (chemically induced)
• Treatment Outcome