***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: 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 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 Older age is a poor prognosis factor in acute myeloid leukemia ( AML ) . This double-blind trial was design ed to test the hypothesis that granulocyte colony-stimulating factor ( G-CSF ) used as supportive care could improve the treatment of elderly AML patients . Two hundred thirty-four patients 55 or more years of age with a morphologic diagnosis of de novo or secondary AML , French-American-British ( FAB ) M0-M7 , excluding M3 , were r and omly assigned to a st and ard induction regimen ( daunorubicin at 45 mg/m2 intravenously [ IV ] on days 1 through 3 and Ara-C at 200 mg/m2 IV continuous infusion on days 1 through 7 ) plus either placebo or G-CSF ( 400 microg/m2 IV over 30 minutes once daily ) . Results are reported here for 211 central ly confirmed cases of non-M3 AML . The two groups were well balanced in demographic , clinical , and hematological parameters , with median ages of 68 years in the G-CSF and 67 years in the placebo groups . The complete response ( CR ) rate was not significantly better in the G-CSF group : 50 % in the placebo and 41 % in the G-CSF group ( one-tailed P = .89 ) . Median overall survival was also similar , 9 months ( 95 % confidence interval [ CI ] , 7 to 10 months ) in the placebo and 6 months ( 95 % CI , 3 to 8 months ) in the G-CSF arms ( P = .71 ) . We found a significant 15 % reduction in the time to neutrophil recovery in the G-CSF group ( P = .014 ) . G-CSF had no impact on recovery from thrombocytopenia ( P = .80 ) or duration of first hospitalization ( P = .27 ) . When infection complications were evaluated , G-CSF had a beneficial effect on the duration but not on incidence of infection .  G-CSF patients had fewer days with fever and shorter duration of antibiotic use . However , there was no difference in the frequency of total documented infections or in the number of fatal infections ( 19 % placebo v 20 % G-CSF ) . In this study of elderly AML patients , G-CSF improved clinical parameters of duration of neutropenia and antibiotic use , but did not change CR rate or survival or shorten hospitalization 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 < 0·0001 ) , but this did not lead to differences in the number , severity or duration of infections . There were no substantial supportive care savings , although G‐CSF patients spent 2 d less in hospital ( P = 0·01 ) . Complete remission ( CR ) rates were similar between arms ( 73 % G‐CSF , 75 % placebo , P = 0·5 ) , as were reasons for failure ( induction death : P = 0·7 ; resistant disease : P = 0·5 ) and , for remitters , 5‐year disease‐free survival ( 34 % vs. 38 % , P = 0·3 ) . Overall survival at 5 years was 29 % with G‐CSF vs. 36 % with placebo ( P = 0·10 ) . Both CR rate ( P = 0·006 ) and overall survival ( P = 0·006 ) were worse with G‐CSF in patients aged < 40 years , but this may be a chance effect . There is some evidence from this trial of an adverse effect of G‐CSF but these data need to be viewed in the context of the evidence from the other trials A r and omized treated/non-treated study of rG.CSF ( 5 micrograms/kg/d , d.i.v . ) in patients with acute myelogenous leukemia was conducted to assess its efficacy on fever ( > or = 38 degrees C ) or documented infection after induction therapy . Of 95 patients enrolled , 46 patients were evaluable for safety and 43 for efficacy in the treated group of 47 patients while 37 of 48 patients were eligible for data analysis in the untreated group . Mare patients showed a recovery in the blood neutrophil count ( to > 1,000/microliters ) during rG.CSF treatment ( 14 days ) than in the non-treated group ( p = 0.039 ) while the number of febrile patients and duration of fever did not significantly differ between the two groups . The treatment with rG.CSF enabled an early recovery in neutrophil count in the patients with neutropenia and overt signs of infection after induction therapy , but there was no hastened allevistion of symptoms of infection in these patients Pre clinical data suggest that retinoids , eg , all-trans retinoic acid ( ATRA ) , lower concentrations of antiapoptotic proteins such as bcl-2 , possibly thereby improving the outcome of anti-acute myeloid leukemia ( AML ) chemotherapy . Granulocyte colony-stimulating factor ( G-CSF ) has been considered to be potentially synergistic with ATRA in this regard . Accordingly , we r and omized 215 patients with newly diagnosed AML ( 153 patients ) or high-risk myelodysplastic syndrome ( MDS ) ( refractory anemia with excess blasts [ RAEB ] or RAEB-t , 62 patients ) to receive fludarabine + ara-C + idarubicin ( FAI ) alone , FAI + ATRA , FAI + G-CSF , or FAI + ATRA + G-CSF .  Eligibility required one of the following : age over 71 years , a history of abnormal blood counts before M.D. And erson ( MDA ) presentation , secondary AML/MDS , failure to respond to one prior course of chemotherapy given outside MDA , or abnormal renal or hepatic function . For the two treatment arms containing ATRA , ATRA was given 2 days ( day-2 ) before beginning and continued for 3 days after completion of FAI . For the two treatment arms including G-CSF , G-CSF began on day-1 and continued until neutrophil recovery . Patients with white blood cell ( WBC ) counts > 50,000/microL began ATRA on day 1 and G-CSF on day 2 . Events ( death , failure to achieve complete remission [ CR ] , or relapse from CR ) have occurred in 77 % of the 215 patients . Reflecting the poor prognosis of the patients entered , the CR rate was only 51 % , median event-free survival ( EFS ) time once in CR was 36 weeks , and median survival time was 28 weeks . A Cox regression analysis indicated that , after accounting for patient prognostic variables , none of the three adjuvant treatment combinations ( FAI + ATRA , FAI + G , FAI + ATRA + G ) affected survival , EFS , or EFS once in CR compared with FAI . Similarly , there were no significant effects of either ATRA ignoring G-CSF , or of G-CSF ignoring ATRA . As previously found , a diagnosis of RAEB or RAEB-t rather than AML was insignificant . There were no indications that the effect of ATRA differed according to cytogenetic group , diagnosis ( AML or MDS ) , or treatment schedule . Logistic regression analysis indicated that , after accounting for prognosis , addition of G-CSF + /- ATRA to FAI improved CR rate versus either FAI or FAI + ATRA , but G-CSF had no effect on the other outcomes . We conclude that addition of ATRA + /- G-CSF to FAI had no effect on CR rate , survival , EFS , or EFS in CR in poor prognosis , newly diagnosed AML or high-risk MDS The optimum chemotherapy schedule for reinduction of patients with high-risk acute myeloid leukemia ( relapsed , resistant/refractory , or adverse genetic disease ) is uncertain . The MRC AML ( Medical Research Council Acute Myeloid Leukemia ) Working Group design ed a trial comparing fludarabine and high-dose cytosine ( FLA ) with st and ard chemotherapy comprising cytosine arabinoside , daunorubicin , and etoposide ( ADE ) . Patients were also r and omly assigned to receive filgrastim ( G-CSF ) from day 0 until neutrophil count was greater than 0.5 x 10(9)/L ( or for a maximum of 28 days ) and all-trans retinoic acid ( ATRA ) for 90 days . Between 1998 and 2003 , 405 patients were entered : 250 were r and omly assigned between FLA and ADE ; 356 to G-CSF versus no G-CSF ; 362 to ATRA versus no ATRA . The complete remission rate was 61 % with 4-year disease-free survival of 29 % . There were no significant differences in the CR rate , deaths in CR , relapse rate , or DFS between ADE and FLA , although survival at 4 years was worse with FLA ( 16 % versus 27 % , P = .05 ) . Neither the addition of ATRA nor G-CSF demonstrated any differences in the CR rate , relapse rate , DFS , or overall survival between the groups . In conclusion these findings indicate that FLA may be inferior to st and ard chemotherapy in high-risk AML and that the outcome is not improved with the addition of either G-CSF or ATRA Summary . To investigate the efficacy and safety of granulocyte colony‐stimulating factor ( G‐CSF ) in patients with acute myelogenous leukaemia , a multicentre r and omized study was performed . From October 1993 to September 1996 , 270 patients with newly diagnosed acute myelogenous leukaemia were r and omized to G‐CSF or control groups after remission induction therapy . The G‐CSF group received G‐CSF ( Filgrastim ) from 48 h after the completing chemotherapy until the absolute neutrophil count exceeded 1·5 × 109/l . The control group did not receive G‐CSF unless severe infection occurred . There were 245 evaluable patients ( 120 and 125 in the G‐CSF and 
    Output:
    
Prophylactic CSF administration reduces the time to neutrophil recovery and length of hospitalization , but has no impact on documented infections or outcome .