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Granulocyte colony-stimulating factor and the risk of secondary myeloid malignancy after etoposide treatment
- Source :
- Blood. 101(10)
- Publication Year :
- 2003
-
Abstract
- Event-free survival for children with acute lymphoblastic leukemia (ALL) now exceeds 80% in the most effective trials. Failures are due to relapse, toxicity, and second cancers such as therapy-related myeloid leukemia or myelodysplasia (t-ML). Topoisomerase II inhibitors and alkylators can induce t-ML; additional risk factors for t-ML remain poorly defined. The occurrence of t-ML among children who had received granulocyte colony-stimulating factor (G-CSF) following ALL remission induction therapy prompted us to examine this and other putative risk factors for t-ML in 412 children treated on 2 consecutive ALL protocols from 1991 to 1998. All children received etoposide and anthracyclines, 99 of whom received G-CSF; 284 also received cyclophosphamide, 58 of whom also received cranial irradiation. There were 20 children who developed t-ML at a median of 2.3 years (range, 1.0-6.0 years), including 16 cases of acute myeloid leukemia, 3 myelodysplasia, and 1 chronic myeloid leukemia. Stratifying by protocol, the cumulative incidence functions differed (P = .017) according to the use of G-CSF and irradiation: 6-year cumulative incidence (standard error) of t-ML of 12.3% (5.3%) among the 44 children who received irradiation without G-CSF, 11.0% (3.5%) among the 85 children who received G-CSF but no irradiation, 7.1% (7.2%) among the 14 children who received irradiation plus G-CSF, and 2.7% (1.3%) among the 269 children who received neither irradiation nor G-CSF. Even when children receiving irradiation were excluded, the incidence was still higher in those receiving G-CSF (P = .019). In the setting of intensive antileukemic therapy, short-term use of G-CSF may increase the risk of t-ML.
- Subjects :
- Oncology
Male
medicine.medical_specialty
Cyclophosphamide
Adolescent
medicine.medical_treatment
Immunology
Biochemistry
Disease-Free Survival
Placebos
Internal medicine
Remission Induction Therapy
Granulocyte Colony-Stimulating Factor
Medicine
Humans
Cumulative incidence
Child
Etoposide
Chemotherapy
business.industry
Incidence (epidemiology)
Incidence
Myeloid leukemia
Infant
Neoplasms, Second Primary
Cell Biology
Hematology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Surgery
Granulocyte colony-stimulating factor
Child, Preschool
Myelodysplastic Syndromes
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 00064971
- Volume :
- 101
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Blood
- Accession number :
- edsair.doi.dedup.....6ff45759dbea1e654edec9f11fb6a7f1