Supportive Care

Infectious disease complications secondary to neu-tropenia are the primary cause of treatment-related morbidity and mortality in acute leukemia, and the risks seem to be especially high in older patients.44 Several studies have focused on preventing prolonged neutropenia in adults with ALL, with prophylactic use of granulocyte-stimulating growth factors.44 124 Two sequential studies of granulocyte colony-stimulating factor (G-CSF) use during induction therapy performed by the GMALL demonstrated a reduction in the duration of neutropenia, a reduction in the number of nonviral infections, and less frequent interruptions in chemotherapy schedules. These benefits, however, did not translate into improved DFS or OS.125

In 1998, the CALGB published results of its large, prospective, randomized trial of G-CSF given during induction and consolidation chemotherapy.44 Subjects who received G-CSF required fewer days to neutrophil recovery following induction chemotherapy for ALL. Subjects in the G-CSF group also had a shorter hospitalization time, a higher CR rate (87% vs 77%), and fewer induction deaths (5% vs 11%). However, G-CSF did not allow for a compressed course of chemotherapy or shorten the overall time required to undergo induction and consolidation. Nevertheless, in patients older than 60 years, the CR rate for patients receiving G-CSF was 81%, compared with 55% in the placebo arm. Despite the improvement in CR rates in older adults, however, none of the studies has demonstrated improvement in DFS or OS when hematopoietic growth factors were added to standard therapies.126

0 0

Post a comment