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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.

Artikel i vetenskaplig tidskrift
Författare Ditte J A Løhmann
Peter H Asdahl
Jonas Abrahamsson
Shau-Yin Ha
Ólafur G Jónsson
Gertjan J L Kaspers
Minna Koskenvuo
Birgitte Lausen
Barbara De Moerloose
Josefine Palle
Bernward Zeller
Henrik Hasle
Publicerad i Pediatric blood & cancer
Volym 66
Nummer/häfte 6
Sidor e27701
ISSN 1545-5017
Publiceringsår 2019
Publicerad vid
Sidor e27701
Språk en
Länkar dx.doi.org/10.1002/pbc.27701
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adolescent, Antineoplastic Combined Chemotherapy Protocols, therapeutic use, Child, Child, Preschool, Clinical Trials as Topic, Cohort Studies, Female, Follow-Up Studies, Granulocyte Colony-Stimulating Factor, adverse effects, Humans, Incidence, Infant, Leukemia, Myeloid, Acute, drug therapy, pathology, Male, Neoplasm Recurrence, Local, diagnosis, epidemiology, etiology, Palliative Care, statistics & numerical data, Prognosis, Risk Factors, Scandinavian and Nordic Countries, epidemiology
Ämneskategorier Pediatrik

Sammanfattning

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.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.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).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.

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