Delayed introduction of G‐CSF after chemotherapy does not affect peripheral blood stem cell yield and engraftment kinetics in children with high‐risk malignancies: Retrospective study of 45 cases

Abstract

We retrospectively compared the effects of two time points of G-CSF (Filgrastim) introduction for PBSC mobilization in 45 children with different malignancies. Seventeen patients received the first G-CSF dose on day 2 or 3 following chemotherapy (group 1). Twenty-eight patients received a "flexible" G-CSF injection schedule when the G-GSF was started at the time of the first platelet count rise during post-chemotherapy recovery phase (group 2). Leukapheresis was performed when WBC recovery reached >2.0 × 10 9 /l or if the peripheral blood CD34 + cell level was >0.01 × 10 9 /l. A median of 2 (1-4) leukapheresis procedures was performed in both groups to yield a median of 4.2 and 6.1 × 10 6 CD34 + cells/kg in groups 1 and 2, respectively, which was generally sufficient for auto-transplantation. The proportion of patients with a failure of PBSC collection was similar and G-CSF consumption estimated through the total cycle dose was 2.3 times less in group 2 without increasing infectious risks. The short-term hematological recovery and the early post-transplant course were similar in the two groups. Delayed introduction of G-CSF after chemotherapy allowed PBSC harvest equivalent to that obtained after early G-CSF introduction. This approach could be an interesting alternative in PBSC mobilization but should be assessed by a prospective controlled study. Am. J. Hematol. 73:225-229, 2003.

Appropriate timing of G‐CSF use after mobilization chemotherapy significantly increases the yield of CD34+ cells in autoPBSCT

“…In previous reports, CD341 cell yields reached 6.7-6.8 3 10 6 /kg body weight [4,6], with a mean of 12-15 days of G-CSF treatment and a mean of 2-5.24 sessions of leukapheresis. The results of Dolgopolov [7] suggest that the G-CSF can be introduced at the time of initial WBC and platelet recovery in all patients without an adverse impact on the studied variables, rather than being introduced immediately after chemotherapy. The patients in this study achieved a yield of 6.1 3 10 6 CD341 cells/kg, with a mean of only 4 days of G-CSF treatment and a median of two sessions of leukapheresis.…”

“…Other centers start using G-CSF at the time of initial WBC or platelet recovery following mobilization [7]. In our earlier procedures for PBSC collection, G-CSF was first used at the point of the first peripheral WBC restoration (the first elevation of WBC count after nadir) following mobilization chemotherapy, according to Dolgopolov [7].…”

Prospective single-arm study of pegfilgrastim activity and safety in children with poor-risk malignant tumours receiving chemotherapy

“…This approach, which implies no more than 5 days of growth factor therapy at most, has proven to be cost effective. 22,23 In this case, the cost of PEG is clearly higher and its use is apparently not justifiable from a solely financial point of view.…”

Efficacy of delayed administration of post-chemotherapy granulocyte colony-stimulating factor: evidence from murine studies of bone marrow cell kinetics

“…Their model showed no major differences in neutrophils engraftment time if the initiation of G-CSF was postponed for up to 5 days after transplantation. Dolgopolov I et al 16 reported a study of G-CSF-stimulated mobilization and harvest CD34+ cells in pediatric patients undergoing chemotherapy. They demonstrated that delayed administration of G-CSF targeted to the time of neutrophil reappearance in peripheral blood after chemotherapy was at least as effective as its "prefixed" start 24 hours after chemotherapy.…”