Granulocyte macrophage colony stimulating factor (GM-CSF) after cyclophosphamide treatment in the 1983 BFM acute lymphoblastic leukaemia protocol improves delivery of scheduled chemotherapy
Of 44 children treated before 1992 with the ALL-BFM 1983 medium risk schedule, 24 experienced a delay in or reduction of scheduled chemotherapy in the two weeks after cyclophosphamide (CP) administrations. Infections occurred in 24.5% and a blood transfusion was administrated in 50.9% of these periods. E. coli recombinant human GM-CSF was given for 7 days, starting on day 4 after CP, to 11 consecutive children treated with the ALL- BFM 83 schedule after 1992. Serial full blood counts and liver function tests were performed. A delay in scheduled treatment occurred in one patient. Infections occurred in 42.4% and a blood transfusion was administered in 48.5% of observation periods. Transient elevations of SGPT and SGOT were observed in both controls and patients, especially when L. asparaginase had preceded CP. No side effects of note were associated with GM-CSF therapy. The addition of GM-CSF significantly improved the ability to deliver scheduled chemotherapy. The infections did not delay planned therapy. Nine of 11 patients are in continued remission after 18- 35 months (mean 27) follow-up. One child is in second remission after a CNS relapse, which was treated with chemotherapy followed by a marrow transplant.