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Pediatr Blood Cancer. 2019 Mar 7:e27701. doi: 10.1002/pbc.27701. [Epub ahead of print]

Use of granulocyte colony-stimulating factor and risk of relapse in pediatric patients treated for acute myeloid leukemia according to NOPHO-AML 2004 and DB AML-01.

Author information

1
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
2
Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
3
Institution for Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.
4
Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong, China.
5
Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland.
6
Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
7
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
8
Dutch Childhood Oncology Group, The Hague, The Netherlands.
9
Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
10
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
11
Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.
12
Department of Woman´s and Children´s Health, Uppsala University, Uppsala, Sweden.
13
Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

Supportive-care use of granulocyte colony-stimulating factor (G-CSF) in pediatric acute myeloid leukemia (AML) remains controversial due to a theoretical increased risk of relapse and limited impact on neutropenic complications. We describe the use of G-CSF in patients treated according to NOPHO-AML 2004 and DB AML-01 and investigated associations with relapse.

PROCEDURE:

Patients diagnosed with de novo AML completing the first week of therapy and not treated with hematopoietic stem cell transplantation in the first complete remission were included (n = 367). Information on G-CSF treatment after each course (yes/no) was registered prospectively in the study database and detailed information was gathered retrospectively from each center. Descriptive statistics were used to describe G-CSF use and Cox regression to assess the association between G-CSF and risk of relapse.

RESULTS:

G-CSF as supportive care was given to 128 (35%) patients after 268 (39%) courses, with a large variation between centers (0-93%). The use decreased with time-the country-adjusted odds ratio was 0.8/diagnostic year (95% confidence interval [CI] 0.7-0.9). The median daily dose was 5 μg/kg (range 3-12 μg/kg) and the median cumulative dose was 75 μg/kg (range 7-1460 μg/kg). Filgrastim was used in 82% of G-CSF administrations and infection was the indication in 44% of G-CSF administrations. G-CSF was associated with increased risk of relapse-the adjusted hazard ratio was 1.5 (95% CI 1.1-2.2).

CONCLUSIONS:

G-CSF as supportive care was used in a third of patients, and use decreased with time. Our results indicate that the use of G-CSF may be associated with an increased risk of relapse.

KEYWORDS:

AML; G-CSF; pediatric; relapse

PMID:
30848067
DOI:
10.1002/pbc.27701

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