Effect of priming with granulocyte colony-stimulating factor on the outcome of chemotherapy for acute myeloid leukemia.

Détails

ID Serval
serval:BIB_28641
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Effect of priming with granulocyte colony-stimulating factor on the outcome of chemotherapy for acute myeloid leukemia.
Périodique
New England Journal of Medicine
Auteur⸱e⸱s
Löwenberg B., van Putten W., Theobald M., Gmür J., Verdonck L., Sonneveld P., Fey M., Schouten H., de Greef G., Ferrant A., Kovacsovics T., Gratwohl A., Daenen S., Huijgens P., Boogaerts M.
Collaborateur⸱rice⸱s
Dutch-Belgian Hemato-Oncology Cooperative Group, Swiss Group for Clinical Cancer Research
ISSN
1533-4406 (Electronic)
ISSN-L
0028-4793
Statut éditorial
Publié
Date de publication
2003
Volume
349
Numéro
8
Pages
743-752
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
BACKGROUND: Sensitization of leukemic cells with hematopoietic growth factors may enhance the cytotoxicity of chemotherapy in acute myeloid leukemia (AML).
METHODS: In a multicenter randomized trial, we assigned patients (age range, 18 to 60 years) with newly diagnosed AML to receive cytarabine plus idarubicin (cycle 1) and cytarabine plus amsacrin (cycle 2) with granulocyte colony-stimulating factor (G-CSF) (321 patients) or without G-CSF (319). G-CSF was given concurrently with chemotherapy only. Idarubicin and amsacrin were given at the end of a cycle to allow the cell-cycle-dependent cytotoxicity of cytarabine in the context of G-CSF to have a greater effect. The effect of G-CSF on disease-free survival was assessed in all patients and in cytogenetically distinct prognostic subgroups.
RESULTS: After induction chemotherapy, the rates of response were not significantly different in the two groups. After a median follow-up of 55 months, patients in complete remission after induction chemotherapy plus G-CSF had a higher rate of disease-free survival than patients who did not receive G-CSF (42 percent vs. 33 percent at four years, P=0.02), owing to a reduced probability of relapse (relative risk, 0.77; 95 percent confidence interval, 0.61 to 0.99; P=0.04). G-CSF did not significantly improve overall survival (P=0.16). Although G-CSF did not improve the outcome in the subgroup with an unfavorable prognosis, the 72 percent of patients with standard-risk AML benefited from G-CSF therapy (overall survival at four years, 45 percent, as compared with 35 percent in the group that did not receive G-CSF [relative risk of death, 0.75; 95 percent confidence interval, 0.59 to 0.95; P=0.02]; disease-free survival, 45 percent vs. 33 percent [relative risk, 0.70]; 95 percent confidence interval, 0.55 to 0.90; P=0.006).
CONCLUSIONS: Sensitization of leukemic cells with growth factors is a clinically applicable means of enhancing the efficacy of chemotherapy in patients with AML.
Mots-clé
Adult, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Cytarabine/administration & dosage, Disease-Free Survival, Female, Granulocyte Colony-Stimulating Factor/therapeutic use, Hematopoietic Stem Cell Mobilization, Humans, Idarubicin/administration & dosage, Leukemia, Myeloid, Acute/drug therapy, Leukemia, Myeloid, Acute/mortality, Male, Middle Aged, Recurrence, Remission Induction, Survival Analysis
Pubmed
Web of science
Création de la notice
19/11/2007 12:25
Dernière modification de la notice
20/08/2019 13:07
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