This study was conducted to determine the maximum tolerated dose of an 
intensified MAID (mesna, adriamycin, ifosfamide, dacarbazine) regimen with the 
support of lenograstim in patients with advanced soft tissue sarcomas. Following 
1 cycle of MAID at the standard dose, four patients were to be treated at each 
of five dosage levels: +25%, +45%, +65%, +85%, +100%. Sixteen patients were 
treated. Because there were no significant differences in hematologic toxicity 
between patients receiving lenograstim 5 or 10 microg/kg/day (levels 1-5 and 
1-10), the data were pooled for comparison with level 2. The median duration of 
absolute neutrophil count < 0.5 x 10(9)/l was 3 days at level 1 and 7 days at 
level 2 (p < 0.01). The median platelet nadir was 25 x 10(9)/l at level 1 and 10 
x 10(9)/l at level 2 (p < 0.01). The median duration of toxicity-related 
hospitalization was 3.5 days and 11 days at levels 1 and 2, respectively, (p < 
0.001). Mucositis > or = grade III occurred after 3/29 cycles at level 1 and 
10/15 cycles at level 2 (p < 0.001). After 4 cycles at level 1, 8/8 patients 
still had performance status scores < or = 2, and only 4/8 had performance 
status scores < or = 2 after the second cycle at level 2. Lenograstim enabled an 
increase of 25% of the MAID regimen. At higher dose levels, severe mucositis and 
deterioration in performance status were dose limiting.