Background: The recruitment effect on leukemic blasts and the enhancement of antileukemic cytotoxicity were the basis of a GM-CSF priming before standard chemotherapy for acute myeloid leukemia (AML) was administered. Material and Methods: After a 24-hour GM-CSF priming (250 μg/m2/day randomly given by continuous intravenous infusion or by once or twice daily subcutaneous injections), a long-term medication of GM-CSF followed until neutrophil recovery. Patients aged 15-60 years received double induction with TAD9 (6-thioguanine, cytosine arabinoside, daunorubicin) and HAM (high-dose cytosine arabinoside, mitoxantrone). Patients aged 60 years and more whose bone marrow was free from blasts after one cycle of TAD 9 received no further induction chemotherapy. Consolidation was TAD9 and maintenance monthly TAD in reduced dose. Results: Independent of the mode of administration neutrophil recovery time could be reduced significantly compared to controls after induction therapy with TAD9, while this effect was lacking in the following courses. During GM-CSF therapy, platelet recovery was delayed after consolidation. GM-CSF treatment seems not to promote a disease progression since there is a trend to a lower rate of persistent leukemia, a more frequent rapid blast clearance and a superior remission duration, significant in patients under 60 years, during a 2.5-year follow-up. Subcutaneous injection of GM-CSF once daily is at least equivalent in hematological effects and therapeutic outcome to the same dose given twice daily by subcutaneous injections and continuous intravenous infusion. Conclusions: Independent of the mode of administration, multiple course priming and long-term administration of GM-CSF may improve the duration of remission and appears not to protect AML against chemotherapy.

Keywords:
Acute myeloid leukemia, Chemotherapy, GM-CSF priming
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© 1994 S. Karger AG, Basel
1994
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