Drugs

, Volume 62, Supplement 1, pp 47–63

The Role of Myelopoietic Growth Factors in Managing Cancer in the Elderly

Review Article

Abstract

More than 50% of all malignancies are diagnosed in patients aged >65 years and most cancer-related deaths occur in this population. Misconceptions about prognosis and treatment contribute to the undertreatment of elderly cancer patients and consequent poor outcomes. Although older patients have been excluded from cancer treatment trials in the past, response rates to chemotherapy in a variety of common cancers in otherwise healthy elderly patients are comparable to those attained in younger patients.

Lower functional reserve in many organ systems alters the pharmacokinetics of chemotherapeutic drugs as well as the patient’s response to treatment-induced toxicity. Except for myelosuppression and mucositis, otherwise fit elderly cancer patients are not at significantly enhanced risk of toxicity to chemotherapy. Severe neutropenia and related infection are encountered much more frequently during the treatment of elderly as compared with younger cancer patients. These lead to treatment delays, dose reductions and higher hospitalisation rates.

Myelopoietic growth factor support reduces myelosuppression and the associated risk of severe infection, thereby allowing delivery of chemotherapy at full dose intensity. Beneficial responses to granulocyte colony-stimulating factor (G-CSF; filgrastim) in elderly patients have been found in aggressive non-Hodgkin’s lymphoma with standard cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) therapy and acute myeloid leukaemia (AML) during induction and consolidation chemotherapy. Granulocyte-macrophage colony-stimulating factor (GM-CSF; sargramostim) has been found to reduce myelosuppression in elderly AML patients receiving induction but not consolidation chemotherapy. These prophylactic treatments produce significant cost benefits because of the reduced hospitalisation and antibiotic use associated with neutropenia.

To maximise positive outcomes, elderly patients should be included in clinical trials of new cancer agents. Since myelosuppression is the main risk factor for elderly patients undergoing chemotherapy, optimisation of growth factor support and the development of more effective and safer myelopoietic agents may improve success rates and reduce adverse events. Such information will lead to better management of cancer in older patients.

References

  1. 1.
    Cancer Facts & Figures 2001. Vol. 2001. Atlanta (GA): American Cancer Society, 2001Google Scholar
  2. 2.
    Lyman GH, Kuderer NM, Balducci L. Cancer care in the elderly: cost and quality-of-life considerations. Cancer Control 1998; 5: 347–54PubMedGoogle Scholar
  3. 3.
    Chen CI, Skingley P, Meyer RM. A comparison of elderly patients with aggressive histology lymphoma who were entered or not entered on to a randomized phase II trial. Leuk Lymphoma 2000; 38: 327–34PubMedCrossRefGoogle Scholar
  4. 4.
    Kemeny M, Muss HB, Kornblith AB, et al. Barriers to participation of older women with breast cancer in clinical trials. Proceedings of the 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA)Google Scholar
  5. 5.
    Mahoney T, Kuo YH, Topilow A, et al. Stage III colon cancers: why adjuvant chemotherapy is not offered to elderly patients. Arch Surg 2000; 135: 182–5PubMedCrossRefGoogle Scholar
  6. 6.
    Clark GM. The biology of breast cancer in older women. J Gerontol 1992; 47: 19–23PubMedCrossRefGoogle Scholar
  7. 7.
    Crivellari D, Bonetti M, Castiglione-Gertsch M, et al. Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. J Clin Oncol 2000; 18: 1412–22PubMedGoogle Scholar
  8. 8.
    Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999; 341: 2061–7PubMedCrossRefGoogle Scholar
  9. 9.
    Begg CB, Carbone PP. Clinical trials and drug toxicity in the elderly: the experience of the Eastern Cooperative Oncology Group. Cancer 1983; 52: 1986–92PubMedCrossRefGoogle Scholar
  10. 10.
    Christman K, Muss HB, Case LD, et al. Chemotherapy of metastatic breast cancer in the elderly. The Piedmont Oncology Association experience. JAMA 1992; 268: 57–62PubMedCrossRefGoogle Scholar
  11. 11.
    Giovanazzi-Bannon S, Rademaker A, Lai G, et al. Treatment tolerance of elderly cancer patients entered onto phase II clinical trials: an Illinois Cancer Center study. J Clin Oncol 1994; 12: 2447–52PubMedGoogle Scholar
  12. 12.
    Ibrahim NK, Frye DK, Buzdar AU, et al. Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer: tolerance and outcome. Arch Intern Med 1996; 156: 882–8PubMedCrossRefGoogle Scholar
  13. 13.
    Dhodapkar MV, Ingle JN, Cha SS, et al. Prognostic factors in elderly women with metastatic breast cancer treated with tamoxifen: an analysis of patients entered on four prospective clinical trials. Cancer 1996; 77: 683–90PubMedCrossRefGoogle Scholar
  14. 14.
    Ibrahim NK, Buzdar AU, Asmar L, et al. Doxorubicin-based adjuvant chemotherapy in elderly breast cancer patients: the MD Anderson experience, with long-term follow-up. Ann Oncol 2000; 11: 1597–601PubMedCrossRefGoogle Scholar
  15. 15.
    Gomez H, Hidalgo M, Casanova L, et al. Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin’s lymphoma: results of a multivariate analysis. J Clin Oncol 1998; 16: 2065–9PubMedGoogle Scholar
  16. 16.
    Radford JA, Whelan JS, Rohatiner AZ, et al. Weekly VAPEC-B chemotherapy for high grade non-Hodgkin’s lymphoma: results of treatment in 184 patients. Ann Oncol 1994; 5: 147–51PubMedCrossRefGoogle Scholar
  17. 17.
    Vitolo U, Bertini M, Brusamolino E, et al. MACOP-B treatment in diffuse large-cell lymphoma: identification of prognostic groups in an Italian multicenter study. J Clin Oncol 1992; 10: 219–27PubMedGoogle Scholar
  18. 18.
    Lancet JE, Willman CL, Bennett JM. Acute myelogenous leukemia and aging: clinical interactions. Hematol Oncol Clin North Am 2000; 14: 251–67PubMedCrossRefGoogle Scholar
  19. 19.
    Balducci L, Extermann M. Cancer and aging: an evolving panorama. Hematol Oncol Clin North Am 2000; 14: 1–16PubMedCrossRefGoogle Scholar
  20. 20.
    Kimmick GG, Balducci L. Breast cancer and aging: clinical interactions. Hematol Oncol Clin North Am 2000; 14: 213–34PubMedCrossRefGoogle Scholar
  21. 21.
    Rockwell S, Hughes CS, Kennedy KA. Effect of host age on microenvironmental heterogeneity and efficacy of combined modality therapy in solid tumors. Int J Radiat Oncol Biol Phys 1991; 20: 259–63PubMedCrossRefGoogle Scholar
  22. 22.
    Stein BN, Petrelli NJ, Douglass HO, et al. Age and sex are independent predictors of 5-fluorouracil toxicity: analysis of a large scale phase III trial. Cancer 1995; 75: 11–7PubMedCrossRefGoogle Scholar
  23. 23.
    Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist 2000; 5: 224–37PubMedCrossRefGoogle Scholar
  24. 24.
    Jacobson SD, Cha S, Sargent DJ, et al. Tolerability, dose intensity, and benefit of 5FU-based chemotherapy for advanced colorectal cancer (CRC) in the elderly. A North Central Cancer Treatment Group (NCCTG) Study. Proceedings of the 37th Annual Meeting of the American Society of Clinical Oncology; 2001 May 12–15; San Francisco(CA)Google Scholar
  25. 25.
    Moscinski LC. Hemopoiesis and aging. In: Balducci L, editor. Comprehensive geriatric oncology. London: Hardwood Academic 1998: 399–412Google Scholar
  26. 26.
    Lipschitz DA. Age-related declines in hematopoietic reserve capacity. Semin Oncol 1995; 22: 3–5PubMedGoogle Scholar
  27. 27.
    Dees EC, O’Reilly S, Goodman SN, et al. A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest 2000; 18: 521–9PubMedCrossRefGoogle Scholar
  28. 28.
    Chaves PH, Volpato S, Fried L. Challenging the World Health Organization criteria for anemia in older women [abstract #A10]. J Am Geriatr Soc 2001; 49: S3CrossRefGoogle Scholar
  29. 29.
    Begg CB, Elson PJ, Carbone PP. A study of excess hematologic toxicity in elderly patients treated on cancer chemotherapy protocols. In: Yancik R, Yates JW, editors. Cancer in the elderly: approaches to early detection and treatment. New York: Springer, 1989: 149–63Google Scholar
  30. 30.
    Colleoni M, Price KN, Castiglione-Gertsch M, et al. Mortality during adjuvant treatment of early breast cancer with cyclophosphamide, methotrexate, and fluorouracil. International Breast Cancer Study Group. Lancet 1999; 354: 130–1PubMedCrossRefGoogle Scholar
  31. 31.
    Dixon DO, Neilan B, Jones SE, et al. Effect of age on therapeutic outcome in advanced diffuse histiocytic lymphoma: the Southwest Oncology Group experience. J Clin Oncol 1986; 4: 295–305PubMedGoogle Scholar
  32. 32.
    Gaynor ER, Dahlberg S, Fisher RI. Factors affecting reduced survival of the elderly with intermediate and high grade lymphoma: an analysis of SWOG-8516 (INT 0067) — the National High Priority Lymphoma Study — a randomized comparison of CHOP vs m-BACOD vs ProMACE-CytaBOM vs MACOP-B [abstract #1250]. Proceedings of the American Society of Clinical Oncology; 1994 May 14–17; Dallas (TX)Google Scholar
  33. 33.
    Tirelli U, Zagonel V, Errante D, et al. Treatment of non-Hodgkin’s lymphoma in the elderly: an update. Hematol Oncol 1998; 16: 1–13PubMedCrossRefGoogle Scholar
  34. 34.
    Sargent D, Goldberg R, Macdonald J, et al. Adjuvant chemotherapy for colon cancer (CC) is beneficial without significantly increased toxicity in elderly patients (Pts): results from a 3351 Pt meta-analysis. Proceedings of the 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA)Google Scholar
  35. 35.
    Langer C, Manola J, Bernardo P, et al. Advanced age alone does not compromise outcome in fit non-small cell lung cancer (NSCLC) patients (Pts) receiving platinum (DDP)-based therapy (TX): implications of ECOG 5592. Proceedings of the 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA)Google Scholar
  36. 36.
    Rosvold E, Langer CJ, McAleer C, et al. Advancing age does not exacerbate toxicity or compromise outcome in non-small cell lung cancer (NSCLC) patients (pts) receiving paclitaxel-carboplatin (P-C). Proceedings of the 35th Annual Meeting of the American Society of Clinical Oncology; 1999 May 15–18; Atlanta (GA)Google Scholar
  37. 37.
    Rowe JM, Andersen JW, Mazza JJ, et al. A randomized placebo-controlled phase III study of granulocyte-macrophage colony-stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia: a study of the Eastern Cooperative Oncology Group (E1490). Blood 1995; 86: 457–62PubMedGoogle Scholar
  38. 38.
    Stone RM, Berg DT, George SL, et al. Granulocyte-macrophage colony-stimulating factor after initial chemotherapy for elderly patients with primary acute myelogenous leukemia. Cancer and Leukemia Group B. N Engl J Med 1995; 332: 1671–7PubMedCrossRefGoogle Scholar
  39. 39.
    Liu Yin JA, Johnson PR, Davies JM, et al. Mitoxantrone and cytosine arabinoside as first-line therapy in elderly patients with acute myeloid leukaemia. Br J Haematol 1991; 79: 415–20PubMedCrossRefGoogle Scholar
  40. 40.
    Dombret H, Chastang C, Fenaux P, et al. A controlled study of recombinant human granulocyte colony-stimulating factor in elderly patients after treatment for acute myelogenous leukemia. AML Cooperative Study Group. N Engl J Med 1995; 332: 1678–83PubMedCrossRefGoogle Scholar
  41. 41.
    Early Breast Cancer Trialists’ Collaborative Group. Poly-chemotherapy for early breast cancer: an overview of the randomised trials. Lancet 1998; 352: 930–42CrossRefGoogle Scholar
  42. 42.
    Extermann M, Balducci L, Lyman GH. What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 2000; 18: 1709–17PubMedGoogle Scholar
  43. 43.
    Meyer RM, Browman GP, Samosh ML, et al. Randomized phase II comparison of standard CHOP with weekly CHOP in elderly patients with non-Hodgkin’s lymphoma. J Clin Oncol 1995; 13: 2386–93PubMedGoogle Scholar
  44. 44.
    Bastion Y, Blay JY, Divine M, et al. Elderly patients with aggressive non-Hodgkin’s lymphoma: disease presentation, response to treatment, and survival: a Groupe d’Etude des Lymphomes de l’Adulte study on 453 patients older than 69 years. J Clin Oncol 1997; 15: 2945–53PubMedGoogle Scholar
  45. 45.
    O’Reilly SE, Connors JM, Howdle S, et al. In search of an optimal regimen for elderly patients with advanced-stage diffuse large-cell lymphoma: results of a phase II study of P/DOCE chemotherapy. J Clin Oncol 1993; 11: 2250–7PubMedGoogle Scholar
  46. 46.
    Gomez H, Mas L, Casanova L, et al. Elderly patients with aggressive non-Hodgkin’s lymphoma treated with CHOP chemotherapy plus granulocyte-macrophage colony-stimulating factor: identification of two age subgroups with differing hematologic toxicity. J Clin Oncol 1998; 16: 2352–8PubMedGoogle Scholar
  47. 47.
    Sonneveld P, de Ridder M, van der Lelie H, et al. Comparison of doxorubicin and mitoxantrone in the treatment of elderly patients with advanced diffuse non-Hodgkin’s lymphoma using CHOP versus CNOP chemotherapy. J Clin Oncol 1995; 13: 2530–9PubMedGoogle Scholar
  48. 48.
    Zinzani PL, Storti S, Zaccaria A, et al. Elderly aggressive-histology non-Hodgkin’s lymphoma: first-line VNCOP-B regimen experience on 350 patients. Blood 1999; 94: 33–8PubMedGoogle Scholar
  49. 49.
    Bjorkholm M, Osby E, Haberg H, et al. Randomized trial of r-metHu granulocyte colony-stimulating factor (G-CSF) as adjunct CHOP or CNOP treatment of elderly patients with aggressive non-Hodgkin’s lymphoma [abstract #2665]. Blood 1999; 94: 527aGoogle Scholar
  50. 50.
    Chatta GS, Price TH, Allen RC, et al. Effects of in vivo recombinant methionyl human granulocyte colony-stimulating factor on the neutrophil response and peripheral blood colony-forming cells in healthy young and elderly adult volunteers. Blood 1994; 84: 2923–9PubMedGoogle Scholar
  51. 51.
    Guerci A, Lederlin P, Reyes F, et al. Effect of granulocyte colony-stimulating factor administration in elderly patients with aggressive non-Hodgkin’s lymphoma treated with a pirarubicin-combination chemotherapy regimen. Groupe d’Etudes des Lymphomes de l’Adulte. Ann Oncol 1996; 7: 966–9PubMedCrossRefGoogle Scholar
  52. 52.
    Zagonel V, Babare R, Merola MC, et al. Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin’s lymphoma treated with combination chemotherapy. Ann Oncol 1994; 5: 127–32PubMedCrossRefGoogle Scholar
  53. 53.
    Heil G, Hoelzer D, Sanz MA, et al. A randomized, double-blind, placebo-controlled, phase III study of filgrastim in remission induction and consolidation therapy for adults with de novo acute myeloid leukemia. The International Acute Myeloid Leukemia Study Group. Blood 1997; 90: 4710–8PubMedGoogle Scholar
  54. 54.
    Bertini M, Freilone R, Vitolo U, et al. The treatment of elderly patients with aggressive non-Hodgkin’s lymphomas: feasibility and efficacy of an intensive multidrug regimen. Leuk Lymphoma 1996; 22: 483–93PubMedCrossRefGoogle Scholar
  55. 55.
    Jacobson JO, Grossbard M, Shulman LN, et al. CHOP chemotherapy with G-CSF in elderly patients with intermediate grade lymphoma (IGL): full dose intensity is possible. Proceedings of the 34th Annual Meeting of the American Society of Clinical Oncology; 1998 May 16–19; Los Angeles (CA)Google Scholar
  56. 56.
    Gregory SA, Case DCJ, Bosserman L, et al. 14 Day CHOP in patients with aggressive non-hodgkin’s lymphoma (NHL): preliminary results. Proceedings of the 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA)Google Scholar
  57. 57.
    Donnelly GB, Glassman J, Long C, et al. Granulocyte-colony stimulating factor (G-CSF) may improve disease outcome in elderly patients with diffuse large cell lymphoma (DLCL) treated with CHOP chemotherapy. Leuk Lymphoma 2000; 39: 67–75PubMedCrossRefGoogle Scholar
  58. 58.
    Pentengell R, Gurney H, Radford JA, et al. Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin’s lymphoma: a randomized controlled trial. Blood 1992; 80: 1430–6Google Scholar
  59. 59.
    Godwin JE, Kopecky KJ, Head DR, et al. A double-blind placebo-controlled trial of granulocyte colony-stimulating factor in elderly patients with previously untreated acute myeloid leukemia: a Southwest Oncology Group Study (9031). Blood 1998; 91: 3607–15PubMedGoogle Scholar
  60. 60.
    Shank Jr WA, Balducci L. Recombinant hemopoietic growth factors: comparative hemopoietic response in younger and older subjects. J Am Geriatr Soc 1992; 40: 151–4PubMedGoogle Scholar
  61. 61.
    de Graaf H, Willemse PH, Bong SB, et al. Dose intensity of standard adjuvant CMF with granulocyte colony-stimulating factor for premenopausal patients with node-positive breast cancer. Oncology 1996; 53: 289–94PubMedCrossRefGoogle Scholar
  62. 62.
    Kim YJ, Rubenstein EB, Rolston KV, et al. Colony stimulating factors (CSFS) may reduce complications and death in solid tumor patients (Pts) with fever and neutropenia. Proceedings of the 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA)Google Scholar
  63. 63.
    Uozumi K, Nakahara K, Takatsuka Y, et al. Granulocyte colony-stimulating factor in the combination chemotherapy for adult T-cell leukemia (ATL). LeukLymphoma 1998; 29: 407–14Google Scholar
  64. 64.
    Cascinu S, Catalano G. Intensive weekly chemotherapy for elderly gastric cancer patients, using 5-fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin and glutathione with the support of G-CSF. Tumori 1995; 81: 32–5PubMedGoogle Scholar
  65. 65.
    Cascinu S, Fedeli A, Luzi Fedeli S, et al. Intensive weekly chemotherapy for advanced gastric cancer using 5-fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin and granulocytecolony stimulating factor. Int J Oncol 1993; 3: 535–8PubMedGoogle Scholar
  66. 66.
    Glaspy JA, Golde DW. Granulocyte colony-stimulating factor (G-CSF): preclinical and clinical studies. Semin Oncol 1992; 19: 386–94PubMedGoogle Scholar
  67. 67.
    Witz F, Sadoun A, Perrin MC, et al. A placebo-controlled study of recombinant human granulocyte-macrophage colony-stimulating factor administered during and after induction treatment for de novo acute myelogenous leukemia in elderly patients. Groupe Ouest Est Leucemies Aigues Myeloblastiques (GOELAM). Blood 1998; 91: 2722–30PubMedGoogle Scholar
  68. 68.
    Lyman GH, Lyman CG, Sanderson RA, et al. Decision analysis of hematopoietic growth factor use in patients receiving cancer chemotherapy. J Natl Cancer Inst 1993; 85: 488–93PubMedCrossRefGoogle Scholar
  69. 69.
    Balducci L, Hardy CL, Lyman GH. Hematopoietic growth factors in the older cancer patient. Curr Opin Hematol 2001; 8: 170–87PubMedCrossRefGoogle Scholar
  70. 70.
    Lyman G, Kuderer N, Greene J, et al. The economics of febrile neutropenia: implications for the use of colony-stimulating factors. Eur J Cancer 1998; 34: 1857–64PubMedCrossRefGoogle Scholar
  71. 71.
    Bennett CL, Stinson TJ, Tallman MS, et al. Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients (> 55 to 70 years of age) with acute myelogenous leukemia. Eastern Cooperative Oncology Group (E1490). Ann Oncol 1999; 10: 177–82PubMedCrossRefGoogle Scholar
  72. 72.
    Bennett CL, Stinson TJ, Laver JH, et al. Cost analyses of adjunct colony stimulating factors for acute leukemia: can they improve clinical decision making. Leuk Lymphoma 2000; 37: 65–70PubMedCrossRefGoogle Scholar
  73. 73.
    Bennett CL, Hynes D, Godwin J, et al. Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial. Cancer Invest 2001; 19: 603–10PubMedCrossRefGoogle Scholar
  74. 74.
    Balducci L, Yates J. General guidelines for the management of older patients with cancer. Oncology (Huntingt) 2000; 14: 221–7Google Scholar
  75. 75.
    Estey EH, Dixon D, Kantarjian HM, et al. Treatment of poor-prognosis, newly diagnosed acute myeloid leukemia with ara-C and recombinant human granulocyte-macrophage colony-stimulating factor. Blood 1990; 75: 1766–9PubMedGoogle Scholar
  76. 76.
    Buchner T, Hiddemann W, Koenigsmann M, et al. Recombinant human granulocyte-macrophage colony-stimulating factor after chemotherapy in patients with acute myeloid leukemia at higher age or after relapse. Blood 1991;78: 1190–7PubMedGoogle Scholar
  77. 77.
    Ozer H, Armitage JO, Bennett CL, et al. ASoCOGFE: 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J Clin Oncol 2000; 18: 3558–85PubMedGoogle Scholar
  78. 78.
    Koumakis G, Vassilomanolakis M, Barbounis V, et al. Optimal timing (preemptive vs supportive) of granulocyte colony-stimulating factor administration following high-dose cyclophosphamide. Oncology 1999; 56: 28–35PubMedCrossRefGoogle Scholar
  79. 79.
    Crawford J, Kreisman H, Garewal H, et al. The impact of filgrastim schedule variation on hematopoietic recovery post-chemotherapy. Ann Oncol 1997; 8: 1117–24PubMedCrossRefGoogle Scholar
  80. 80.
    Cleeland CS, Demetri GD, Glaspy J, et al. Identifying hemoglobin level for optimal quality of life: results of an incremental analysis. Proceedings of the 35th Annual Meeting of the American Society of Clinical Oncology; 1999 May 15–18; Atlanta (GA)Google Scholar
  81. 81.
    Jantunen E, Mahlamaki E, Nousiainen T. Feasibility and toxicity of high-dose chemotherapy supported by peripheral blood stem cell transplantation in elderly patients (>/=60 years) with non-Hodgkin’s lymphoma: comparison with patients /=60 years) with non-Hodgkin’s lymphoma (NHL). Bone Marrow Transplant 2000; 26: 737–41PubMedCrossRefGoogle Scholar
  82. 82.
    Montillo M, Tedeschi A, Pagano L, et al. Feasibility of peripheral blood stem cell rescue as intensification in elderly patients with acute myelocytic leukaemia: a pilot study from the Gimema Group. Gruppo Italiano Malattie Ematologiche Maligne Dell’Adulto. Br J Haematol 2000; 111: 334–7PubMedCrossRefGoogle Scholar
  83. 83.
    Palumbo A, Triolo S, Baldini L, et al. Dose-intensive melphalan with stem cell support (CM regimen) is effective and well tolerated in elderly myeloma patients. Haematologica 2000; 85: 508–13PubMedGoogle Scholar
  84. 84.
    Green M, Koelbl H, Baselga J, et al. A randomized, double-blind, phase 3 study evaluating fixed-dose, once-per-cycle pegylated filgrastim (SD/01) vs daily filgrastim to support chemotherapy for breast cancer. Proceedings of the 37 th Annual Meeting of the American Society of Clinical Oncology; 2001 May 12–15; San Francisco (CA)Google Scholar
  85. 85.
    Holmes FA, O’Shaughnessy JA, Vukelja S, et al. A single dose of pegylated filgrastim (SD/01) is as effective as daily filgrastim for hematologic support of chemotherapy in breast cancer patients: results of a randomized, double-blind, phase 3 trial. Proceedings of the 37th Annual Meeting of the American Society of Clinical Oncology; 2001 May 12–15; San Francisco (CA)Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Senior Adult Oncology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  2. 2.Cattedra di Oncologia MedicaUniversita degli StudiPalermoItaly

Personalised recommendations