Annals of Hematology

, Volume 93, Issue 2, pp 193–202 | Cite as

Long-term results of a prospective randomized trial evaluating G-CSF priming in intensive induction chemotherapy followed by autologous stem cell transplantation in elderly patients with acute myeloid leukemia

  • Gesine Bug
  • Steffen Koschmieder
  • Juergen Krauter
  • Michael Heuser
  • Felicitas Thol
  • Stefanie Wiebe
  • Wolf-Karsten Hofmann
  • Stefan A. Klein
  • Gerd Wegener
  • Gudrun Göhring
  • Wolfgang Heit
  • Dieter Hoelzer
  • Arnold Ganser
  • Oliver G. OttmannEmail author
Original Article


Few studies have evaluated granulocyte colony-stimulating factor (G-CSF) priming in elderly patients with intensively treated acute myeloid leukemia (AML), and no data are available for genetically defined AML subgroups. We provide long-term results (median follow-up 7.6 years) of a randomized trial in which 183 patients (median age 67 years) received G-CSF prior to (G-CSF priming) or after two cycles of induction chemotherapy. CR rates with G-CSF priming and G-CSF post-chemotherapy were comparable (57 vs. 67 %, p = 0.153), with overall survival (OS) probabilities of 14 vs. 17 % at 10 years. Induction mortality was significantly higher with G-CSF priming (23 vs. 10 %, p = 0.015), primarily in normal karyotype (NK) AML. In this subgroup, a trend for better relapse-free survival (RFS) was observed with G-CSF priming (44 vs. 22 % at 10 years, p = 0.074) but did not translate into an OS benefit. G-CSF priming had no impact on AML with FLT3-ITD and NPM mutations and did not improve outcome in patients with adverse cytogenetics. In a landmark analysis, late consolidation with autologous stem cell transplantation or a second consolidation cycle significantly improved RFS compared with one consolidation cycle (21.0 vs. 12.8 months, p = 0.046). Future studies on G-CSF priming should be restricted to NK AML and used only in post-remission therapy.


Acute myeloid leukemia G-CSF priming Monosomal karyotype FLT3-ITD Autologous stem cell transplantation 



The authors would like to thank Caroline Zander, Gabriele Samson, and Emilia Januschewski for the excellent data management. This study was supported by an unrestricted grant from Amgen GmbH and Pfizer GmbH by the Deutsche Krebshilfe e.V (grant no. 109003) and grant no. DJCLS R 10/22 from the Deutsche-José-Carreras Leukämie-Stiftung e.V (DJCLS). OGO holds an endowed professorship of the DJCLS.

Conflict of interest

The authors declare no conflict of interest.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

277_2013_1873_MOESM1_ESM.doc (38 kb)
Supplemental figure 1 Consort diagram of the trial. (DOC 37 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Gesine Bug
    • 1
  • Steffen Koschmieder
    • 2
  • Juergen Krauter
    • 3
  • Michael Heuser
    • 3
  • Felicitas Thol
    • 3
  • Stefanie Wiebe
    • 4
  • Wolf-Karsten Hofmann
    • 5
  • Stefan A. Klein
    • 5
  • Gerd Wegener
    • 3
  • Gudrun Göhring
    • 6
  • Wolfgang Heit
    • 7
  • Dieter Hoelzer
    • 1
  • Arnold Ganser
    • 3
  • Oliver G. Ottmann
    • 1
    • 8
    Email author
  1. 1.Department of Medicine II, Hematology/OncologyUniversity Hospital FrankfurtFrankfurtGermany
  2. 2.Department of Medicine IV, Oncology, Hematology and Stem Cell TransplantationUniversity Hospital of RWTH AachenAachenGermany
  3. 3.Department of Hematology, Hemostasis, Oncology and Stem Cell TransplantationMedical School HannoverHannoverGermany
  4. 4.Medizinische Klinik AUniversitätsklinikum MünsterMünsterGermany
  5. 5.Department of Hematology and OncologyMedical Faculty Mannheim of the University of HeidelbergMannheimGermany
  6. 6.Institute of PathologyMedical School HannoverHannoverGermany
  7. 7.Medizinische KlinikEvangelisches Krankenhaus Essen-WerdenEssen-WerdenGermany
  8. 8.Medizinische Klinik II, Abteilung Hämatologie und OnkologieUniversitätsklinikum FrankfurtFrankfurtGermany

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