The hematologic toxicity of high-dose cytarabine-based induction regimens has typically been greater than that associated with 7 and 3 regimens. Toxicity with high-dose cytarabine includes myelosuppression, pulmonary toxicity, and significant and occasionally irreversible cerebellar toxicity. All patients treated with high-dose cytarabine must be closely monitored for cerebellar toxicity. Full cerebellar testing should be performed before each dose, and further high-dose cytarabine should be withheld if evidence of cerebellar toxicity develops. This toxicity occurs more commonly in patients with renal impairment and in those over age 60. The increased toxicity observed with high-dose cytarabine has limited the use of this. | Chapter 104. Acute and Chronic Myeloid Leukemia Part 8 The hematologic toxicity of high-dose cytarabine-based induction regimens has typically been greater than that associated with 7 and 3 regimens. Toxicity with high-dose cytarabine includes myelosuppression pulmonary toxicity and significant and occasionally irreversible cerebellar toxicity. All patients treated with high-dose cytarabine must be closely monitored for cerebellar toxicity. Full cerebellar testing should be performed before each dose and further high-dose cytarabine should be withheld if evidence of cerebellar toxicity develops. This toxicity occurs more commonly in patients with renal impairment and in those over age 60. The increased toxicity observed with high-dose cytarabine has limited the use of this therapy in elderly AML patients. Supportive Care Measures geared to supporting patients through several weeks of granulocytopenia and thrombocytopenia are critical to the success of AML therapy. Patients with AML should be treated in centers expert in providing supportive measures. Recombinant hematopoietic growth factors have been incorporated into clinical trials in AML. These trials have been designed to lower the infection rate after chemotherapy. Both G-CSF and granulocyte-macrophage colony-stimulating factor GM-CSF have reduced the median time to neutrophil recovery by an average of 5-7 days. This accelerated rate of neutrophil recovery however has not generally translated into significant reductions in infection rates or shortened hospitalizations. In most randomized studies both G-CSF and GM-CSF have failed to improve the CR rate disease-free survival or overall survival. Although receptors for both G-CSF and GM-CSF are present on AML blasts therapeutic efficacy is neither enhanced nor inhibited by these agents. The use of growth factors as supportive care for AML patients is controversial. We favor their use in elderly patients with complicated courses those receiving intensive .
