Effects of recombinant human granulocyte-macrophage colony-stimulating factor in an intensive treatment program for children with Ewing's sarcoma

R. Luksch, M. Massimino, G. Cefalo, F. Lombardi, A. Ferrari, M. Casanova, L. Gandola, M. Terenziani, F. Spreafico, F. Fossati-Bellani

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Abstract

Background and Objectives. A treatment program including polychemotherapy at progressively escalating doses and sequential hemi-body irradiation (HBI) was adopted between 1987-1994 at our Pediatric Unit for high risk Ewing's sarcoma. Granulocyte-macrophage colony-stimulating factor (GM-CSF) was added to the treatment program in a phase II study fashion to evaluate, in a pediatric setting, its tolerability, as well as its impact on drug dose escalation and on the need for supportive care. Design and Methods. The study was open-label and sequential; GM-CSF administration (5 μg/Kg s.c./d ×10) was planned after each chemotherapy cycle and after each HBI session in 18 consecutive patients (group A). Thirty-eight additional patients (group B) were treated by the same therapeutic program, without GM-CSF. In 12 patients (6 in each group) long-term bone marrow cultures (LTBMC) were performed to evaluate the myeloproliferative potential throughout the chemotherapeutic program. Results. Seven of 18 (39%) patients experienced side effects from GM-CSF; 3/7 discontinued GM-CSF due to anaphylactic symptoms. The degree of neutropenia, as well as the frequency of infectious episodes and the need for supportive care were significantly lower in group A than in group B. latrogenic thrombocytopenia, and the possibility of performing drug-dose escalation were similar in the two groups. The 5-year event-free survival probabilities for group A and B were similar. LTBMC showed that the chemotherapy-related depletion of myeloid precursors could be more pronounced in patients receiving GM-CSF cyclically. Interpretation and Conclusions. In this series, GM-CSF was shown to be effective on iatrogenic neutropenia and related complications, with no impact on thrombopoiesis, drug dose escalation and outcome.

Original languageEnglish
Pages (from-to)753-760
Number of pages8
JournalHaematologica
Volume86
Issue number7
Publication statusPublished - 2001

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Keywords

  • Chemotherapy
  • Ewing's sarcoma
  • GM-CSF
  • Radiotherapy

ASJC Scopus subject areas

  • Hematology

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