***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To determine whether macrophage colony-stimulating factor ( M-CSF ) reduces the incidence and duration of febrile neutropenia during three courses of intensive consolidation therapy and whether it shortens time to complete consolidation therapy . PATIENTS AND METHODS In 198 adult patients with acute myeloid leukemia ( AML ) in complete remission ( CR ) , M-CSF ( 8 x 10(6 ) U/d ) or placebo was administered from 1 day after the end of each consolidation chemotherapy for 14 days . RESULTS The duration and incidence of febrile neutropenia was significantly reduced by 34 % ( P = .00285 ) and 17 % ( P = .02065 ) , respectively , in 88 assessable patients in the M-CSF group compared with those in 94 assessable patients in the placebo group . Patients in the M-CSF group had 565 days and 133 episodes of febrile neutropenia during 7,901 days at risk , while patients in the placebo group had 977 days and 185 episodes during 9,077 days at risk . The median period required to finish the three courses of consolidation therapy was 93 days in the M-CSF group , which was significantly shorter than 110 days in placebo group ( P = .0050 ) . In the M-CSF group , the recovery of neutrophils and platelets was significantly faster ( P = .0348 and P = 0.0364 , respectively ) , the administration of systemic antimicrobial agents tended to be less ( P = .0839 ) , and the frequency of platelet transfusion ( P = .0259 ) and the total volume of transfused platelets ( P = .0292 ) were significantly less . However , there was no significant difference in the disease-free survival . CONCLUSION M-CSF significantly reduced the incidence and duration of febrile neutropenia during the intensive consolidation therapy , and shortened the time to complete consolidation chemotherapy in AML Prospect i ve studies have shown rapid engraftment using granulocyte-colony-stimulating factor-mobilized peripheral blood stem cells ( G-PBSCs ) for allogeneic transplantation , though the risks for graft-versus-host disease ( GVHD ) may be increased . It was hypothesized that the use of G-CSF to prime bone marrow ( G-BM ) would allow rapid engraftment without increased risk for GVHD compared with G-PBSC .  Patients were r and omized to receive G-BM or G-PBSCs for allogeneic stem cell transplantation . The study was design ed ( beta < .8 ) to detect a difference in the incidence of chronic GVHD of 33 % ( alpha < .05 ) . The plan was to recruit 100 patients and to conduct an interim analysis when the 6-month follow-up point was reached for the first 50 patients . Fifty-seven consecutive patients were recruited ( G-BM , n = 28 ; G-PBSC , n = 29 ) . Patients in the G-PBSC group received 3-fold more CD34(+ ) and 9-fold more CD3(+ ) cells . Median times to neutrophil ( G-BM , 16 days ; G-PBSC , 14 days ; P < .1 ) and platelet engraftment ( G-BM , 14 days ; G-PBSC , 12 days ; P < .1 ) were similar . The use of G-PBSC was associated with steroid refractory acute GVHD ( G-BM , 0 % ; G-PBSC , 32 % ; P < .001 ) , chronic GVHD ( G-BM , 22 % ; G-PBSC , 80 % ; P < .02 ) , and prolonged requirement for immunosuppressive therapy ( G-BM , 173 days ; G-PBSC , 680 days ; P < .009 ) . Survival was similar for the 2 groups . Compared with G-PBSC , the use of G-BM result ed in comparable engraftment , reduced severity of acute GVHD , and less subsequent chronic GVHD The optimal induction for older adults with acute myeloid leukemia ( AML ) is unknown . Several anthracyclines have been proposed , but the data remain equivocal . Additionally , few prospect i ve trials of priming with hematopoietic growth factors to cycle leukemia cells prior to induction chemotherapy have been conducted . Three hundred and sixty-two older adults with previously untreated AML were r and omized to either daunorubicin , idarubicin or mitoxantrone with a st and ard dose of cytarabine as induction therapy .  In addition , 245 patients were also r and omized to receive granulocyte-macrophage colony-stimulating factor ( GM-CSF ) or placebo beginning 2 days prior to induction chemotherapy and continuing until marrow aplasia . No difference was observed in the disease-free overall survival or in toxicity among patients receiving any of the 3 induction regimens or among those receiving growth factor or placebo for priming . However , the complete remission rate for the first 113 analyzable patients , who did not participate in the priming study and started induction therapy 3 to 5 days earlier than those who did , was significantly higher ( 50 % versus 38 % ; P = .03 ) . None of the anthracyclines is associated with improved outcome in older adults . Priming with hematopoietic growth factor did not improve response when compared with placebo . Furthermore , delaying induction therapy in older adults may lead to a lower complete remission rate In an attempt to improve induction chemotherapy for older patients with acute myeloid leukemia (AML),1314 patients were r and omized to 1 of 3 induction treatments for 2 courses of DAT ( daunorubicin , cytarabine , and thioguanine ) 3 + 10 , ADE ( daunorubicin , cytarabine , and etoposide ) 10 + 3 + 5 , or MAC ( mitoxantrone-cytarabine ) . The remission rate in the DAT arm was significantly better than ADE ( 62 % vs 50 % ; P = .002 ) or MAC ( 62 % vs 55 % ; P = .04 ) . This benefit was seen in patients younger and older than 70 years . There were no differences between the induction schedules with respect to overall survival at 5 years ( 12 % vs 8 % vs 10 % ) . A total of 226 patients were r and omized to receive granulocyte colony-stimulating factor ( G-CSF ) or placebo as supportive care from day 8 after the end of treatment course 1 . The remission rate or survival were not improved by G-CSF , although the median number of days to recover neutrophils to 1.0 x 10(9)/L was reduced by 5 days . Patients who entered remission ( n = 371 ) were r and omized to stop after a third course ( DAT 2 + 7 ) or after 6 courses , ie , a subsequent COAP ( cyclophosphamide , vincristine , cytarabine , and prednisolone ) , DAT 2 + 5 , and COAP . The relapse risk ( 81 % vs 73 % ) , disease-free survival ( 16 % vs 23 % ) , and overall survival at 5 years ( 23 % vs 22 % ) did not differ between the 3-course or 6-course arms . In addition to a treatment duration r and omization , 362 patients were r and omized to receive 12-month maintenance treatment with low-dose interferon , but no benefit was seen with respect to relapse risk , disease-free survival , or overall survival Background : This study was performed to examine the feasibility and toxicity of the combination of mitoxantrone , fludarabine , cytarabine as bolus ( B ) or continuous infusion ( CI ) and granulocyte- colony stimulating factor ( G-CSF ) in patients with recurrent and refractory acute myeloid leukemia ( AML ) . Patients and Methods : 29 patients with relapsed ( n = 17 ) or refractory ( n = 12 ) AML were treated with the Mito-FLAG protocol consisting of mitoxantrone ( 7 mg/m2 , days 1/3/5 ) , fludarabine ( 15mg/m2 , every 12 h , days 1–5 ) , cytarabine ( Ara-C ) as bolus infusion ( 1000 mg/m2 over 1 h , every 12 h , days 1–5 ) ( n = 15 ) or as continuous infusion ( 100–150 mg/m2 over 24 h , days 1–5 ) ( n = 14 ) , and G-CSF ( 5 µg/ kg/day , day 0 until a neutrophile count of 0.5 ×109/l ) . Results : 17 patients ( 59 % ) and 1 patient ( 3 % ) achieved complete remission ( CR ) and partial remission ( PR ) , respectively ; thus the overall response rate was 62 % . Following Mito-FLAG , 5 patients with CR underwent high-dose therapy ( HDT ) with allogeneic ( n = 2 ) or autologous ( n = 3 ) stem cell transplantation (SCT).With a median follow-up of 28 ( range 6–54 ) months , 4 transplanted patients are alive in CR ( n = 2 ) or in relapse ( n = 2 ) . The median duration of event-free survival ( EFS ) and overall survival ( OS ) was 3.2 and 6.8 months , and probabilities of EFS and OS after 1 year were 14 and 34 % , respectively . The 1-year rates for EFS and OS in this group were 18 and 53 % , respectively . Median duration of WHO grade 4 granulocytopenia and thrombocytopenia was 20 and 23 days , respectively . Nonhematological side effects were moderate , predominantly reaching WHO grade s 1–2 . Neutropenic fever was seen in 85 % of courses , with a median duration of 4 ( 1–38 ) days . Four patients ( 14 % ) suffered an early death because of aplasia ( n = 2 ) , pneumonia ( n = 1 ) or progressive AML ( 1 nonresponding patient ) . Conclusions : Our data suggest that the Mito-FLAG protocol is feasible and can be safely performed with both schedules of Ara-C. In this study the regimens have shown high efficacy and acceptable toxicity in patients with relapsed or refractory AML . We currently examine the importance of bolus versus continuous infusion of Ara-C as part of the Mito-FLAG regimen in a prospect i ve r and omized multicenter trial The role of glycosylated recombinant human granulocyte colony-stimulating factor ( G-CSF ) in the induction treatment of older adults with acute myeloid leukemia ( AML ) is still uncertain . In this trial , a total of 722 patients with newly diagnosed AML , median age 68 years , were r and omized into 4 treatment arms : ( A ) no G-CSF ; ( B ) G-CSF during chemotherapy ; ( C ) G-CSF after chemotherapy until day 28 or recovery of polymorphonuclear leukocytes ; and ( D ) G-CSF during and after chemotherapy . The complete remission ( CR ) rate was 48.9 % in group A , 52.2 % in group B , 48.3 % in group C , and 64.4 % in group D. Analysis according to the 2 x 2 factorial design indicated that the CR rate was significantly higher in patients who received G-CSF during chemotherapy ( 58.3 % for groups B + D vs 48.6 % for groups A + C ; P = .009 ) , whereas no significant difference was observed between groups A + B and C + D ( 50.6 % vs 56.4 % , P = .12 ) . In terms of overall survival , no significant differences were observed between the various groups . Patients who received G-CSF after chemotherapy had a shorter time to neutrophil recovery ( median , 20 vs 25 days ; P < .001 ) and a shorter hospitalization ( mean , 27.2 vs 29.7 days ; P < .001 ) . We conclude that although priming with G-CSF can improve the CR rate , the use of G-CSF during and /or after chemotherapy has no effect on the long-term outcome of AML in older patients St and ard intensive induction therapy is tolerated poorly by elderly patients with acute myeloblastic leukemia ( AML ) . We treated 19 elderly patients with AML , including seven with a prior myelodysplastic syndrome ( MDS ) with a combination of low dose cytarabine , hydroxyurea , and GM‐CSF . The percentage of blasts in S‐phase was evaluated prior to and 24 hr after starting the GM‐CSF infusion . Cell cycle analysis was performed by flow cytometry using propidium iodine staining with fluorescein isothiocyanate‐conjugated monoclonal antibody to the myeloid antigen CD 33 The role of granulocyte colony stimulating factor ( G‐CSF ) as supportive therapy following intensive induction chemotherapy for acute myeloid leukaemia ( AML ) in adults was investigated in a r and omized trial . G‐CSF ( Lenograstim , 263 μg/d ) or placebo was administered from day 8 after the end of chemotherapy until neutrophil recovery to 0·5 × 109/l ( or for up to 10 d ) . Eight hundred and three patients were entered . Neutrophil recovery was quicker with G‐CSF ( P < 0 
    Output:
    
In summary , colony-stimulating factors should not be given routinely to acute myelogenous leukemia patients post-chemotherapy since they do not affect overall survival or infectious parameters including the rate of bacteremias and invasive fungal infections