Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia

Alfonso Quintas-Cardama, Hagop Kantarjian, Susan O'Brien, Guillermo Garcia-Manero, Mary B. Rios, Moshe Talpaz, Jorge Cortes

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Imatinib mesylate administration has become standard treatment for patients with chronic myelogenous leukemia (CML). Although the safety profile of imatinib is favorable, Grade ≥ 3 neutropenia (according to the National Cancer Institute Common Toxicity Criteria) occurs in 35-45% of patients with CML in chronic phase who receive standard-dose imatinib. Myelosuppression results in treatment interruptions, which may compromise responses to imatinib. The authors investigated the ability of granulocyte-colony-stimulating factor (filgrastim) to reverse imatinib-associated neutropenia, thereby allowing for more continuous imatinib administration. METHODS. Thirteen patients with chronic-phase CML and Grade ≥ 3, imatinib-induced neutropenia were treated with filgrastim. Treatment with filgrastim was initiated after a median of 22 months from the start of imatinib. Eleven patients received filgrastim 5 μg/kg 1-3 times weekly, and 2 patients received filgrastim 5 μg/kg daily; doses were titrated to maintain an absolute neutrophil count (ANC) ≥ 109/L. RESULTS. Seven of 11 patients (64%) who began treatment with an ANC < 1.5 × 109/L had responses (i.e., their ANC improved to ≥ 2 × 109/L within 21 days); the other 4 patients experienced slower recovery but were able to continue receiving imatinib uninterrupted. Before filgrastim administration was initiated, patients did not receive imatinib (due to neutropenia-related treatment interruptions) for an average of 21% of the total time since the start of imatinib. This figure decreased to 6% after the start of filgrastim treatment (P = 0.0008). Before filgrastim treatment was initiated, only one patient had achieved a major (partial) cytogenetic response. After the start of filgrastim treatment, five patients had major cytogenetic responses (including two complete responses). CONCLUSIONS. The authors concluded that filgrastim may overcome imatinib-associated neutropenia and allow improved delivery of imatinib. Some patients may experience improvements in their responses to therapy as a result.

Original languageEnglish (US)
Pages (from-to)2592-2597
Number of pages6
JournalCancer
Volume100
Issue number12
DOIs
StatePublished - Jun 15 2004
Externally publishedYes

Fingerprint

Leukemia, Myeloid, Chronic Phase
Granulocyte Colony-Stimulating Factor
Neutropenia
Neutrophils
Therapeutics
Cytogenetics
Imatinib Mesylate
Filgrastim
National Cancer Institute (U.S.)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive

Keywords

  • Absolute neutrophil count
  • Cytogenetic response
  • Filgrastim
  • Imatinib-induced neutropenia
  • Myelosuppression

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia. / Quintas-Cardama, Alfonso; Kantarjian, Hagop; O'Brien, Susan; Garcia-Manero, Guillermo; Rios, Mary B.; Talpaz, Moshe; Cortes, Jorge.

In: Cancer, Vol. 100, No. 12, 15.06.2004, p. 2592-2597.

Research output: Contribution to journalArticle

Quintas-Cardama, Alfonso ; Kantarjian, Hagop ; O'Brien, Susan ; Garcia-Manero, Guillermo ; Rios, Mary B. ; Talpaz, Moshe ; Cortes, Jorge. / Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia. In: Cancer. 2004 ; Vol. 100, No. 12. pp. 2592-2597.
@article{a91f48579f29460a8d8cd60d960be55c,
title = "Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia",
abstract = "BACKGROUND. Imatinib mesylate administration has become standard treatment for patients with chronic myelogenous leukemia (CML). Although the safety profile of imatinib is favorable, Grade ≥ 3 neutropenia (according to the National Cancer Institute Common Toxicity Criteria) occurs in 35-45{\%} of patients with CML in chronic phase who receive standard-dose imatinib. Myelosuppression results in treatment interruptions, which may compromise responses to imatinib. The authors investigated the ability of granulocyte-colony-stimulating factor (filgrastim) to reverse imatinib-associated neutropenia, thereby allowing for more continuous imatinib administration. METHODS. Thirteen patients with chronic-phase CML and Grade ≥ 3, imatinib-induced neutropenia were treated with filgrastim. Treatment with filgrastim was initiated after a median of 22 months from the start of imatinib. Eleven patients received filgrastim 5 μg/kg 1-3 times weekly, and 2 patients received filgrastim 5 μg/kg daily; doses were titrated to maintain an absolute neutrophil count (ANC) ≥ 109/L. RESULTS. Seven of 11 patients (64{\%}) who began treatment with an ANC < 1.5 × 109/L had responses (i.e., their ANC improved to ≥ 2 × 109/L within 21 days); the other 4 patients experienced slower recovery but were able to continue receiving imatinib uninterrupted. Before filgrastim administration was initiated, patients did not receive imatinib (due to neutropenia-related treatment interruptions) for an average of 21{\%} of the total time since the start of imatinib. This figure decreased to 6{\%} after the start of filgrastim treatment (P = 0.0008). Before filgrastim treatment was initiated, only one patient had achieved a major (partial) cytogenetic response. After the start of filgrastim treatment, five patients had major cytogenetic responses (including two complete responses). CONCLUSIONS. The authors concluded that filgrastim may overcome imatinib-associated neutropenia and allow improved delivery of imatinib. Some patients may experience improvements in their responses to therapy as a result.",
keywords = "Absolute neutrophil count, Cytogenetic response, Filgrastim, Imatinib-induced neutropenia, Myelosuppression",
author = "Alfonso Quintas-Cardama and Hagop Kantarjian and Susan O'Brien and Guillermo Garcia-Manero and Rios, {Mary B.} and Moshe Talpaz and Jorge Cortes",
year = "2004",
month = "6",
day = "15",
doi = "10.1002/cncr.20285",
language = "English (US)",
volume = "100",
pages = "2592--2597",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "12",

}

TY - JOUR

T1 - Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia

AU - Quintas-Cardama, Alfonso

AU - Kantarjian, Hagop

AU - O'Brien, Susan

AU - Garcia-Manero, Guillermo

AU - Rios, Mary B.

AU - Talpaz, Moshe

AU - Cortes, Jorge

PY - 2004/6/15

Y1 - 2004/6/15

N2 - BACKGROUND. Imatinib mesylate administration has become standard treatment for patients with chronic myelogenous leukemia (CML). Although the safety profile of imatinib is favorable, Grade ≥ 3 neutropenia (according to the National Cancer Institute Common Toxicity Criteria) occurs in 35-45% of patients with CML in chronic phase who receive standard-dose imatinib. Myelosuppression results in treatment interruptions, which may compromise responses to imatinib. The authors investigated the ability of granulocyte-colony-stimulating factor (filgrastim) to reverse imatinib-associated neutropenia, thereby allowing for more continuous imatinib administration. METHODS. Thirteen patients with chronic-phase CML and Grade ≥ 3, imatinib-induced neutropenia were treated with filgrastim. Treatment with filgrastim was initiated after a median of 22 months from the start of imatinib. Eleven patients received filgrastim 5 μg/kg 1-3 times weekly, and 2 patients received filgrastim 5 μg/kg daily; doses were titrated to maintain an absolute neutrophil count (ANC) ≥ 109/L. RESULTS. Seven of 11 patients (64%) who began treatment with an ANC < 1.5 × 109/L had responses (i.e., their ANC improved to ≥ 2 × 109/L within 21 days); the other 4 patients experienced slower recovery but were able to continue receiving imatinib uninterrupted. Before filgrastim administration was initiated, patients did not receive imatinib (due to neutropenia-related treatment interruptions) for an average of 21% of the total time since the start of imatinib. This figure decreased to 6% after the start of filgrastim treatment (P = 0.0008). Before filgrastim treatment was initiated, only one patient had achieved a major (partial) cytogenetic response. After the start of filgrastim treatment, five patients had major cytogenetic responses (including two complete responses). CONCLUSIONS. The authors concluded that filgrastim may overcome imatinib-associated neutropenia and allow improved delivery of imatinib. Some patients may experience improvements in their responses to therapy as a result.

AB - BACKGROUND. Imatinib mesylate administration has become standard treatment for patients with chronic myelogenous leukemia (CML). Although the safety profile of imatinib is favorable, Grade ≥ 3 neutropenia (according to the National Cancer Institute Common Toxicity Criteria) occurs in 35-45% of patients with CML in chronic phase who receive standard-dose imatinib. Myelosuppression results in treatment interruptions, which may compromise responses to imatinib. The authors investigated the ability of granulocyte-colony-stimulating factor (filgrastim) to reverse imatinib-associated neutropenia, thereby allowing for more continuous imatinib administration. METHODS. Thirteen patients with chronic-phase CML and Grade ≥ 3, imatinib-induced neutropenia were treated with filgrastim. Treatment with filgrastim was initiated after a median of 22 months from the start of imatinib. Eleven patients received filgrastim 5 μg/kg 1-3 times weekly, and 2 patients received filgrastim 5 μg/kg daily; doses were titrated to maintain an absolute neutrophil count (ANC) ≥ 109/L. RESULTS. Seven of 11 patients (64%) who began treatment with an ANC < 1.5 × 109/L had responses (i.e., their ANC improved to ≥ 2 × 109/L within 21 days); the other 4 patients experienced slower recovery but were able to continue receiving imatinib uninterrupted. Before filgrastim administration was initiated, patients did not receive imatinib (due to neutropenia-related treatment interruptions) for an average of 21% of the total time since the start of imatinib. This figure decreased to 6% after the start of filgrastim treatment (P = 0.0008). Before filgrastim treatment was initiated, only one patient had achieved a major (partial) cytogenetic response. After the start of filgrastim treatment, five patients had major cytogenetic responses (including two complete responses). CONCLUSIONS. The authors concluded that filgrastim may overcome imatinib-associated neutropenia and allow improved delivery of imatinib. Some patients may experience improvements in their responses to therapy as a result.

KW - Absolute neutrophil count

KW - Cytogenetic response

KW - Filgrastim

KW - Imatinib-induced neutropenia

KW - Myelosuppression

UR - http://www.scopus.com/inward/record.url?scp=2642553015&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2642553015&partnerID=8YFLogxK

U2 - 10.1002/cncr.20285

DO - 10.1002/cncr.20285

M3 - Article

C2 - 15197801

AN - SCOPUS:2642553015

VL - 100

SP - 2592

EP - 2597

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 12

ER -