Complete haematological
response with granulocyte colony stimulating factor (G-CSF) and
hydroxyurea in relapsed acute myeloid leukaemia (AML) of the
elderly
Lionello Camba, Massimo Bernardi, Alessandra Pescarollo
Ematologia e Trapianto di Midollo Osseo, Ospedale San Raffaele,
Milan, Italy.
Correspondence: Lionello Camba, Ematologia e Trapianto di Midollo
Osseo, Ospedale S Raffaele, via Olgettina 60, 20132 Milan. Italy.
E-mail: lionello.camba@hsr.it
Text
Sastre et al.1 report
on a case of complete response obtained with
granulocyte-macrophage colony stimulating factor (GM-CSF) and low
dose cytarabine in an elderly patient with refractory AML. We
would like to describe an elderly patient with relapsed AML, who
responded to G-CSF and hydroxyurea. The patient presented in
August 1998, aged 75, with anaemia, leucocytosis and 10% blast
cells in the peripheral blood. Bone marrow aspirate confirmed the
diagnosis of LMA-M4 and normal cytogenetics. He was treated with
the Manchester Protocol (cytarabine 100 mg/m2x2 for 5
days, mitoxanthrone 4 mg/m2 for 4 days)2 and
went in to C.R. after the 2nd induction course. He was then
consolidated with intermediate dose of Cytosine-arabinoside (1
g/m2/day for 6 days) and Idarubicin (10
mg/m2/day for 3 days). He relapsed after 16 months in
January 2001. Because of his age he was treated conservatively
with blood and platelet transfusions and put on Hydroxyurea to
contain his leukaemia. G-CSF was started for his severe
neutropenia. The haematological indices improved gradually, he
became transfusion-independent, and by week 12 from starting
treatment he was in C.R. without haematological or other
complications (Table).
G-CSF was then reduced. He is currently on 300 mg 10 days and HU
0.5 g/day.
Achievement of C.R. in elderly patients with G-CSF with and
without chemotherapy has been described.2,3 G-CSF is
used in elderly AML patients to achieve rapid neutrophil recovery
and to prime myeloblast growth to the cytotoxic action of
chemotherapy4 but C.R. rate and long term survival are
not convincingly affected.5,6 Large studies on the use
of G-CSF or GM-CSF with non-myelotoxic low dose chemotherapy in
elderly AML patients have not been systematically undertaken. Such
studies might be able to establish whether this approach is worth
pursuing: the high degree of compliance, the absence of
myelotoxicity, the outpatient-only management make this treatment
ideal for such patient population. Finally, why in a number of
patients G-CSF is able to induce C.R. by restoring an effective
haemopoiesis and repressing the leukaemic proliferation remains
unknown. Differentiation of blast cells and stimulation of the
non-leukaemic cell population may be
hypothesised.7
