mercaptopurine and Chemotherapy-Induced-Febrile-Neutropenia

We analyzed the effects of granulocyte colony-stimulating factor (G-CSF) on outcomes in 315 anthracycline-based induction chemotherapy-treated patients with non-M3 acute myelogenous leukemia (AML). Patients were classified as follows: no G-CSF administration during induction (no G-CSF group; 112 patients); administration immediately upon neutropenia onset (absolute neutrophil counts (ANC)<1000/μL), but before febrile neutropenia (preemptive group; 74 patients); and administration following febrile neutropenia development (therapeutic group; 129 patients). G-CSF users had a shorter time to ANC recovery than the no G-CSF group (p<0.001). The chemotherapy-induced febrile neutropenia (CIFN) duration was significantly shorter in the preemptive group than in other groups (p<0.001). The incidence of CIFN was not significantly different between preemptive and non-G-CSF users (84.8% versus 82.4%). Preemptive G-CSF administration modestly improved treatment-related mortality (TRM), compared with no G-CSF administration (p=0.076 in multivariate analysis). G-CSF administration did not affect relapse-free or overall survivals or the cumulative relapse incidence among the groups. In conclusion, preemptive G-CSF administration reduced CIFN duration and modestly improved TRM without affecting chemotherapy outcomes. These effects were not observed in the therapeutic group; therefore, initiation of G-CSF during induction therapy before the development of febrile neutropenia may be desirable.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anthracyclines; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy-Induced Febrile Neutropenia; Cyclophosphamide; Cytarabine; Daunorubicin; Female; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Mortality; Remission Induction; Republic of Korea; Retrospective Studies; Treatment Outcome; Young Adult