Journal of Clinical Oncology, Vol 10, 1955-1962, Copyright © 1992 by American Society of Clinical Oncology
Granulocyte-macrophage colony-stimulating factor or granulocyte colony- stimulating factor infusion makes high-dose etoposide a safe outpatient regimen that is effective in lymphoma and myeloma patients
AM Gianni, M Bregni, S Siena, M Magni, M Di Nicola, F Lombardi, C Tarella, A Pileri and G Bonadonna
Cristina Gandini Bone Marrow Transplantation Unit, Istituto Nazionale Tumori, Milan, Italy.
PURPOSE: This study assessed the efficacy of recombinant human
granulocyte-macrophage colony-stimulating factor (rhGM-CSF) or recombinant
human granulocyte colony-stimulating factor (rhG-CSF) in ameliorating the
extent and duration of hematologic toxicity after high- dose etoposide
cancer therapy. PATIENTS AND METHODS: Thirty-two non- Hodgkin's lymphoma
and myeloma patients were treated with 2 to 2.4 g/m2 etoposide infused
intravenously (IV) during a 10- to 12-hour period, followed 72 hours later
by subcutaneous administration of rhGM-CSF or rhG-CSF. Hematologic toxicity
was compared with that observed in 29 patients who were treated with
high-dose etoposide without growth factors. RESULTS: The median duration of
grade 4 neutropenia in growth factor-treated patients was 3 days, and
granulocyte counts never decreased to less than 100/microL in approximately
half of the patients. The corresponding figures in the control patients
were 8 and 3 days, respectively (P < .0001). No effect was observed in
platelet and RBC recovery. Growth factor-treated patients became eligible
to receive additional myelotoxic chemotherapy a median of 5 days earlier
than controls. Nonhematologic toxicity was minimal. Grade 1 mucositis was
observed in two of 61 patients (3%). Antitumor activity assessed within 1
month after etoposide administration was documented in 58% of 38 assessable
patients. Finally, high-dose etoposide expanded and mobilized the pool of
peripheral-blood hematopoietic progenitors. CONCLUSION: The use of rhGM-CSF
or rhG-CSF makes high-dose etoposide a safe outpatient regimen and should
encourage the inclusion of this highly effective and well-tolerated drug in
novel treatment strategies that use high-dose therapy early in the clinical
course of chemosensitive tumors.
