Stem Cells, Vol 13, 472-476, Copyright © 1995 by AlphaMed Press
Perspective of rhGM-CSF in the treatment of neutropenic infections and aggressive lymphomas
HH Gerhartz
Med. Dept. III, Klinikum Grosshadern, Munich, Germany.
Non-Hodgkin lymphomas (NHL) of intermediate and high-grade malignancy
respond well to doxorubicin-containing regimens, but long-term survival
does not exceed 30% in large studies with long-term follow-up. Any attempt
to improve this somehow disappointing result by adding more drugs,
increasing doses or shortening time intervals of chemotherapy have so far
failed in randomized settings. Even autologous bone marrow transplantation
(ABMT) could not improve long-term survival when applied in first remission
of the disease. Prophylactic use of hematopoietic growth factors in the
chemotherapy of aggressive NHL did prevent neutropenia and positively
influenced the occurrence of infectious complications, and also led to an
increase of dose intensity (DI) by 15% but this did not affect survival. In
contrast, a retrospective analysis of an NHL study showed that a high DI
may in fact be deleterious rather than beneficial. Thus the prophylactic
use of hematopoietic growth factors still has to be considered experimental
in the chemotherapy of NHL and should be studied in controlled settings
like the one proposed here.
