CHICAGO--Findings from the Cancer and Leukemia Group B (CALGB)
may support the routine use of G-CSF (Neupogen) during the induction
phase of therapy in elderly patients with acute lymphoblastic
leukemia (ALL), Richard Larson, MD, said at the Ninth Annual Meeting
of the Network for Oncology Communication & Research, based
Although the trials--randomized, double-blind studies of G-CSF
conducted by CALGB institutions since 1991--included only a small
number of elderly patients, Dr. Larson feels that the findings
are clear-cut in this age group, thus justifying routine use of
the growth factor in this situation.
In these trials, elderly patients (age 60 or older) with ALL who
were given G-CSF took the same time to recover 1,000 granulocytes
as did younger individuals given G-CSF (median, 16 days versus
15 days for those under age 60). "That was somewhat unexpected,"
said Dr. Larson, associate professor of medicine, University of
In addition, when compared with placebo, G-CSF produced a much
quicker recovery of granulocytes in elderly patients. Compared
with those given G-CSF, recovery of 1,000 granulocytes took 6
days longer in younger patients who received a placebo; it took
13 days longer in elderly patients given placebo.
More important, this difference appeared to affect remission rates,
Dr. Larson said. G-CSF patients under the age of 60 had a 92%
complete response rate, compared with 86% for the placebo group.
The complete response rate for G-CSF patients over the age of
60 was 85% versus only 69% for elderly patients given placebo.
Effects in Younger Patients
The effects of G-CSF and GM-CSF are less clear in younger patients,
Dr. Larson said. Several major clinical trials of these growth
factors in the treatment of ALL in the United States and Europe
have failed to demonstrate any improvement in complete response
rate in this younger age group.