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Effect of priming with granulocyte-macrophage colony-stimulating factor in younger adults with newly diagnosed acute myeloid leukemia: a trial by the Acute Leukemia French Association (ALFA) Group.

Authors
  • Thomas, X
  • Raffoux, E
  • Botton, S de
  • Pautas, C
  • Arnaud, P
  • de Revel, T
  • Reman, O
  • Terré, C
  • Corront, B
  • Gardin, C
  • Le, Q-H
  • Quesnel, B
  • Cordonnier, C
  • Bourhis, J-H
  • Elhamri, M
  • Fenaux, P
  • Preudhomme, C
  • Michallet, M
  • Castaigne, S
  • Dombret, H
Type
Published Article
Journal
Leukemia
Publication Date
Mar 01, 2007
Volume
21
Issue
3
Pages
453–461
Identifiers
PMID: 17252021
Source
Medline
License
Unknown

Abstract

In a multicenter trial, 259 young adults (15-49 years) with newly diagnosed acute myeloid leukemia (AML) were first randomized to receive a timed-sequential induction regimen given either alone (135 patients) or concomitantly with granulocyte-macrophage colony-stimulating factor (GM-CSF) (124 patients). Patients reaching complete remission (CR) were then randomized to compare a timed-sequential consolidation to a postremission chemotherapy including four cycles of high-dose cytarabine followed by maintenance courses. In the appropriate arm, GM-CSF was given concurrently with chemotherapy during all cycles of consolidation. CR rates were significantly better in the GM-CSF arm (88 vs 78%, P<0.04), but did not differ after salvage. Patients receiving GM-CSF had a higher 3-year event-free survival (EFS) estimate (42 vs 34%), but GM-CSF did not impact on overall survival. Patients with intermediate-risk cytogenetics benefited more from GM-CSF therapy (P=0.05) in terms of EFS than patients with other cytogenetics. This was also confirmed when considering only patients following the second randomization, or subgroups defined by a prognostic index based on cytogenetics and the number of courses required for achieving CR. Priming of leukemic cells with hematopoietic growth factors is a means of enhancing the efficacy of chemotherapy in younger adults with AML.

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