What is your practice regarding giving G-CSF to patients with ALL during initial induction?

My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection.

The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by pushing available stem cell to the myeloid line.

So the short answer is, we do not give it routinely.

We take a similar approach. We generally reserve G-CSF for treatment of severe neutropenia with fever or documented infection, which is not particularly common with this regimen.

An example of the evidence alluded to by Dr. @Dr. First Last is the CALGB 9111 trial (Larson et al., PMID 9716583). This was a randomized double-blind trial of filgrastim vs placebo in adults with newly-diagnosed ALL. Filgrastim did shorten the time to recovery of neutrophils and (perhaps ironically) platelets, and it led to shorter times in the hospital, but it did not significantly impact overall toxicity or survival.

Another general pearl about the use of G-CSF with this regimen has to do with the time at which subsequent cycles of treatment can start. If G-CSF...