Use of granulocyte colony stimulating factor to reduce the toxicity of super-VAC chemotherapy in advanced solid tumours in childhood

Authors

  • Cheryl A. Jones MB BS,

    1. Department of Oncology, The Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia
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  • Dr. Peter J. Shaw MA, MB BS, MRCP, FRACP,

    Corresponding author
    1. Department of Oncology, The Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia
    • Department of Oncology, The Royal Alexandra Hospital for Children, Camperdown, NSW, 2050, Australia
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  • Michael M. Stevens MB BS, FRACP

    1. Department of Oncology, The Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia
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Abstract

Children with advanced solid tumours at the Royal Alexandra Hospital for Children (RAHC) receive an intensive four drug chemotherapy combination, Super-VAC (cyclophosphamide, 500 mg/m2, adriamycin, 30 mg/m2, actinomycin-D, 0.5 mg/m2, all daily for 3 days, and vincristine, 1.5 mg/m2 weekly). The majority of patients respond well to three courses of such therapy, but with considerable morbidity, including fever, neutropenia, and mucositis. In an attempt to reduce the morbidity of Super-VAC, G-CSF was added. We documented various parameters in 12 patients who received 28 cycles with G-CSF and compared them to an historical control group of 37 cycles in the preceding 14 patients who received Super-VAC. The median duration of each cycle was 23 days with G-CSF and 28 days without G-CSF (P = 0.004). However, differences in requirements for inpatient care (median 16 v. 20 days), intravenous antibiotics (median 9 v. 10 days), amphotericin (median 5 v. 3 days), morphine (median 8.5 v. 7 days), or TPN (median 6.5 v. 8 days) did not reach statistical significance. As expected, a significant difference in neutrophil recovery was demonstrated between the two groups (median 11 v. 16 days, P < 0.0001) but not in platelet recovery (median 13 v. 13 days). The use of G-CSF with Super-VAC resulted in a shorter cycle length, so increasing the dose intensity. A reduction in morbidity could not be demonstrated. No toxic side effects from G-CSF were noted. © 1995 Wiley-Liss, Inc.

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