Late G-CSF after allogeneic bone marrow or peripheral blood stem cell transplantation: a prospective controlled trial

Abstract

Summary:Granulocyte colony-stimulating factor (G-CSF) is widely used to accelerate neutrophil recovery after allogeneic BMT or PBSC transplantation. The optimal time to start G-CSF treatment is not known. Forty-two patients undergoing allogeneic BMT or PBSC transplantation for hematological malignancies received G-CSF either on day 6 or on day 9 post transplant. The time to hematological recovery was monitored and the two groups were compared with respect to peritransplant morbidity and mortality. Recovery of the neutrophil counts to Ͼ0.1 ؋ 10 9 /l, Ͼ 0.5 ؋ 10 9 /l and Ͼ1.0 ؋ 10 9 /l were not significantly different in either group. There was no difference in recovery of red blood cell and platelet counts and no difference between the two groups with respect to the number of febrile days or number of days on antibiotic treatment. Documented bacterial, viral or fungal infections did not occur more often when G-CSF treatment was started on day 9. Delaying treatment with G-CSF resulted in a significant reduction in the length of treatment from 13 to 10 days (23.1% reduction). Reducing the length of the treatment by 3 days lowered the costs by 395.40 Euro per patient. Delaying G-CSF treatment and starting on day 9 after BMT or PBSC transplantation is safe and results in a clear economic benefit.

Optimal use of G-CSF administration after hematopoietic SCT

“…12,13,55,57,58,62 Some studies did not report the route or dose used in their studies. 56,60 The criteria for discontinuing G-CSF treatment after allogeneic transplant was variable in these studies: on the day of ANC 4500/ml; 58 or after ANC 4500/ml  2 days; 62,63 or after ANC 4500/ml  3 days 13,60 or ANC 41000/ml  3 days 12,57,64,65 or ANC 43000/ml  1 day. 55 Owing to the small number of studies, we overlooked the variability of the parameters mentioned above in various studies and assume that the outcomes analyzed below are not influenced by this variability.…”

“…Most of the studies addressing the optimal time to initiate G-CSF were conducted in patients receiving BM products; [63][64][65]68 however, one study also included patients receiving allogeneic PBSCT 68 (Table 6). Filgrastim was the most commonly used growth factor, whereas two studies used lenograstim at a dose of 263 mg per day.…”

“…The studies, including three RCTs in the BMT setting, did not find a significant difference in the time to neutrophil engraftment when giving G-CSF early (day 0 to þ 4) vs late (Xday þ 5) after allogeneic transplantation. [63][64][65]68 In most of the studies, neutrophil engraftment was achieved by day þ 16 to day þ 18. There was also no difference in the time to plt engraftment, incidence of acute GVHD or post-transplant hospital stay between the early and delayed initiation of G-CSF.…”

“…Filgrastim was the most commonly used growth factor, whereas two studies used lenograstim at a dose of 263 mg per day. 64 The criteria for discontinuing G-CSF treatment after transplant was variable: on the day of Use of G-CSF after HSCT M Trivedi et al ANC 4500/ml  2 days, 63 ANC 41000/ml, 68 or WBC 41000/ml  3 days. 64,65 Outcomes.…”

“…64 The criteria for discontinuing G-CSF treatment after transplant was variable: on the day of Use of G-CSF after HSCT M Trivedi et al ANC 4500/ml  2 days, 63 ANC 41000/ml, 68 or WBC 41000/ml  3 days. 64,65 Outcomes. The studies, including three RCTs in the BMT setting, did not find a significant difference in the time to neutrophil engraftment when giving G-CSF early (day 0 to þ 4) vs late (Xday þ 5) after allogeneic transplantation.…”