Treatment of acute myeloid leukemia with cytokines: effect on duration of neutropenia and response to infections.

Clinical data regarding the use of colony-stimulating factors for the treatment of acute myeloid leukemia (AML) are conflicting because of varying study conditions. Interpretation of data is affected by differences in patients' ages, induction regimens, the timing of growth factor administration, the presence of marrow hypoplasia, disease states, differences in the products used, and statistical endpoints. Most trials of granulocyte colony-stimulating factor (GM-CSF) have demonstrated a significant shortening of neutrophil recovery time and a trend toward higher rates of complete remission. Several studies have demonstrated a significant reduction in the rates of morbidity or early mortality with G-CSF or GM-CSF. In vitro data support the concept of enhancing antimicrobial activity with macrophage colony-stimulating factor or GM-CSF. The safety and potential benefit of these cytokines suggest that cytokines should be administered to patients receiving induction therapy for AML who are at high risk for therapy-related morbidity and mortality.