Preliminary Results of Treatment with Filgrastim for Relapse of Leukemia and Myelodysplasia after Allogeneic Bone Marrow Transplantation

Giralt, Sergío; Escudier, Susan; Kantarjian, Hagop M.; Deisseroth, Albert; Freireich, Emil J.; Andersson, Börje S.; O’Brien, Susan; Andreeff, Michael; Fisher, Harold; Cork, Ann; Hirsch-Ginsberg, Cheryl F; Trujillo, José M.; Stass, Sanford A.; Champlin, Richard E.

doi:10.1056/nejm199309093291103

Cited by 97 publications

(42 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[32][33][34] None of the trials published up to now, have shown an increased relapse rate in patients treated with G-CSF post-transplantation. 4,[9][10][11][12][13][14][15]33,34 This is in line with our data and we observed relapse in three of 22 patients receiving rhG-CSF and in seven of 25 patients without rhG-CSF.…”

Section: Discussionmentioning

confidence: 99%

Influence of recombinant human granulocyte colony-stimulating factor (filgrastim) on hematopoietic recovery and outcome following allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors

Bertz

Schmoor

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF, filgrastim) on hematopoietic recovery and clinical outcome in patients undergoing allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors (VUD) were analyzed retrospectively. Additionally, the influence of baseline patient and transplant characteristics on hematopoietic recovery was evaluated. From January 1994 to March 1996, 47 consecutive adult patients received VUD-BMT. GVHD prophylaxis was cyclosporin A/short course methotrexate/prednisolone, and in four patients additional ATG. Post-transplantation, cohorts of patients received rhG-CSF (5 g/kg/day) (n ‫؍‬ 22) or no rhG-CSF (n ‫؍‬ 25) in a non-randomized manner. The patient groups with and without rhG-CSF were rather comparable with respect to baseline patient and transplant characteristics. Median time to neutrophil counts (ANC) Ͼ500/ l was 14 days with rhG-CSF vs 16 days without rhG-CSF (P ‫؍‬ 0.048), to ANC Ͼ1000/ l was 15 vs 18 days (P ‫؍‬ 0.084). Neutrophil recovery was accelerated in patients receiving more than the median MNC dose of 2.54 ؋ 10 8 /kg with a median time to ANC Ͼ1000/ l of 13 days vs 19 days (P ‫؍‬ 0.017). RhG-CSF did not influence platelet recovery and incidence of infectious complications. Incidence of acute GVHD II-IV was 50% with rhG-CSF and 28% without rhG-CSF (P ‫؍‬ 0.144), but death before acute GVHD II-IV occurred in 9% of patients with and 20% of patients without rhG-CSF. The median follow-up time was 38 and 36 months in patients with and without rhG-CSF, respectively. Survival at 2 years post-transplant was 39% (95% confidence interval (18%, 60%)) in patients with rhG-CSF and 24% (95% confidence interval (7%, 41%)) in patients without rhG-CSF. Administration of rhG-CSF after VUD-BMT may lead to more rapid neutrophil recovery, but did not influence the incidence of

show abstract

Section: Discussionmentioning

confidence: 99%

Influence of recombinant human granulocyte colony-stimulating factor (filgrastim) on hematopoietic recovery and outcome following allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors

Bertz

Schmoor

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8][9][10][11]13 Our results raise the possibility that this heterogeneity in response may be explained on the basis of relative G-CSFR isoform expression. Leukemic cells which proliferate but fail to terminally differentiate in response to G-CSF may express abnormally high levels or fail to down-regulate the expression of the differentiation-defective class IV isoform, while the leukemic cells of patients who respond to G-CSF by entering into remission may express and regulate levels of the class IV isoform similar to normal myeloid cells.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies with G-CSF explored its potential as a treatment for acute myelogenous leukemia (AML), with hopes that it would drive leukemic myeloid cells to terminally differentiate. 5 While a few cases of G-CSF-induced remission of AML have been described, [6][7][8] in the overwhelming majority of cases of AML, G-CSF-induced maturation is either incomplete or absent, while the proliferative response of these cells to G-CSF persists. 5,[8][9][10][11][12][13] The basis for this aberrant maturational response of leukemic myeloid cells to G-CSF is unknown.…”

Section: Introductionmentioning

confidence: 99%

Increased expression of the differentiation-defective granulocyte colony-stimulating factor receptor mRNA isoform in acute myelogenous leukemia

et al. 1998

View full text Add to dashboard Cite

“…All died of disease progression, 126, 29 and 37 days after relapse, respectively. Patient 25 received only G-CSF for disease control 16 and failed to respond. Subsequent treatment was limited to intermittent steroids for an idiopathic thrombocytopenic purpura (ITP)-like syndrome.…”

Section: Cytogenetic Patterns At Relapsementioning

confidence: 99%

Outcomes of patients with AML and MDS who relapse or progress after reduced intensity allogeneic hematopoietic cell transplantation

Pollyea

Artz

Stock

et al. 2007

Bone Marrow Transplant

View full text Add to dashboard Cite

We describe treatment, outcomes and prognostic factors for patients who relapse following transplantation with a reduced intensity conditioning regimen. Seventy consecutive patients with high-risk myeloid malignancies underwent transplant and 25 (36%) relapsed, a median of 120 days later. The median percentage of bone marrow blasts at relapse was 24, the median donor chimerism was 73% and new karyotypic abnormalities occurred in 8 out of 20 (40%) evaluable patients. Twenty-one patients (84%) received aggressive treatment for relapse, including chemotherapy (60%), second hematopoietic cell transplantation (HCT; 52%) and/or donor lymphocyte infusion (DLI; 12%). Thirteen achieved a complete response (CR) and four remain in CR. Median overall survival (OS) after relapse was 6 months (95% confidence interval ¼ 2.7-9.9 months), and actuarial 1 year OS was 24%. Most deaths were due to disease progression (17/20, 85%). We did not observe an advantage for cellular therapy (DLI or second transplant) compared to chemotherapy. Salvage therapy for relapse after reduced intensity HCT is feasible, associated with low treatment-related mortality, and may result in prolonged survival in select patients. Studies exploring the optimal treatment for relapse following reduced intensity HCT are warranted.

show abstract

Preliminary Results of Treatment with Filgrastim for Relapse of Leukemia and Myelodysplasia after Allogeneic Bone Marrow Transplantation

Abstract: Filgrastim may be effective in selected cases of leukemic relapse after allogeneic bone marrow transplantation.

Cited by 97 publications

References 17 publications

Influence of recombinant human granulocyte colony-stimulating factor (filgrastim) on hematopoietic recovery and outcome following allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors

Influence of recombinant human granulocyte colony-stimulating factor (filgrastim) on hematopoietic recovery and outcome following allogeneic bone marrow transplantation (BMT) from volunteer unrelated donors

Increased expression of the differentiation-defective granulocyte colony-stimulating factor receptor mRNA isoform in acute myelogenous leukemia

Outcomes of patients with AML and MDS who relapse or progress after reduced intensity allogeneic hematopoietic cell transplantation

Contact Info

Product

Resources

About