Journal Article

Monocyte-Macrophages, Granulocyte-Macrophage Colony-Stimulating Factor, and Prolonged Survival Among Patients with Acute Myeloid Leukemia and Stem Cell Transplants

Francis Joseph Giles

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 26, issue 6, pages 1282-1289
Published in print June 1998 | ISSN: 1058-4838
Published online June 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/516361
Monocyte-Macrophages, Granulocyte-Macrophage Colony-Stimulating Factor, and Prolonged Survival Among Patients with Acute Myeloid Leukemia and Stem Cell Transplants

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Recombinant GM-CSF has been recently shown to prolong survival of elderly patients with acute myeloid leukemia (AML) by reducing the rate of induction therapy–related mortality. In a prospective, randomized, placebo-controlled, double-blind, multicenter study conducted by the Eastern Cooperative Oncology Group in the United States, granulocyte-macrophage colony-stimulating factor (GM-CSF) was given only to those patients who had hypocellular or remission marrow on day 10 of one or two cycles of standard induction therapy. Although the administration of GMCSF significantly reduced a wide range of adverse events, the main benefit of this cytokine seems to be mediated by a reduction in sepsis. A similarly designed study, conducted by the Southwest Oncology Group in a directly comparable AML patient population with use of granulocyte colonystimulating factor (G-CSF) as the supportive cytokine, showed no survival benefit and no reduction in the rates of serious or lethal sepsis. In most current clinical situations, GM-CSF and G-CSF are indistinguishable both in terms of efficacy and toxicity. GM-CSF and G-CSF have very different impacts on the survival of patients with AML. The stimulation of monocyte-macrophage function and proliferation by GM-CSF may mediate the selective benefit of GM-CSF in patients with AML and stem cell transplants. GM-CSF merits further study as therapy for and/or protection against opportunistic sepsis in patients with cancer and will be included in a number of International Oncology Study Group protocols.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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