Use of G-CSF to hasten neutrophil recovery after auto-SCT for AML is not associated with increased relapse incidence: a report from the Acute Leukemia Working Party of the EBMT

Abstract

Application of G-CSF in AML is controversial as leukemic blasts may express receptors interacting with the cytokine, which may stimulate leukemia growth. We retrospectively analyzed the impact of G-CSF use to accelerate neutrophil recovery after auto-SCT on outcome. Adults with AML in first CR autografted between 1994 and 2010 were included. Nine hundred and seventy two patients were treated with G-CSF after auto-SCT whereas 1121 were not. BM and PB were used as a source of stem cells in 454 (22%) and 1639 (78%) cases, respectively. The incidence of relapse at 5 years in the BM-auto-SCT group was 38% for patients receiving post-transplant G-CSF and 43% for those not treated with G-CSF, P = 0.46. In the PB-auto-SCT cohort, respective probabilities were 48% and 49%, P = 0.49. No impact of the use of G-CSF could be demonstrated with respect to the probability of leukemia-free survival: in the BM-auto-SCT group, 51% for G-CSF(+) and 48% for G-CSF(− ), P = 0.73; in PB-auto-SCT group, 42% for G-CSF(+) and 43% for G-CSF( − ), P = 0.83. Although G-CSF administration significantly shortened the neutropenic phase, no beneficial effect was observed with regard to non-relapse mortality. In patients with AML, the use of G-CSF after auto-SCT is not associated with increased risk of relapse irrespective of the source of stem cells used.Bone Marrow Transplantation (2014) 49, 950-954;

Long‐term follow‐up of patients with acute myeloid leukemia surviving and free of disease recurrence for at least 2 years after autologous stem cell transplantation: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

“…As demonstrated in a series of prospective and retrospective investigations, the above 3 factors reflect the most important general predictors of outcome in patients with AML, and are still important in the long-term follow-up. [1][2][3][4][5][6]9,18,19 In the current study, the use of PB as a source of stem cells was associated with a higher RI and inferior LFS compared with when BM was used. The role of the stem cell source was demonstrated in previous European Society for Blood and Marrow Transplantation studies by Gorin et al, in which patient outcome was analyzed from the day of auto-SCT.…”

“…Nevertheless, the prognostic significance of cytogenetics was apparent in a univariate analysis, and karyotype risk groups were strongly associated with FAB subtypes. As demonstrated in a series of prospective and retrospective investigations, the above 3 factors reflect the most important general predictors of outcome in patients with AML, and are still important in the long‐term follow‐up …”

“…According to the results of large registry‐based retrospective analyses, disease recurrence affects approximately 45% of patients with AML who are treated with auto‐SCT in CR . The majority of these events occur early after transplantation, and it is believed that the risk of disease recurrence after 2 years is marginal .…”

“…According to the results of large registry-based retrospective analyses, disease recurrence affects approximately 45% of patients with AML who are treated with auto-SCT in CR. 8,18,19 The majority of these events occur early after transplantation, and it is believed that the risk of disease recurrence after 2 years is marginal. [2][3][4][5][6]18,19 Results from the current study clearly indicate that this assumption is incorrect, because the cumulative RI at 10 years reached 16%, which represented the major cause of treatment failure among long-term survivors.…”

Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects

“…35,36 Using the same regimen, researchers in Nanjing Relevant to this study, an EBMT retrospective analysis showed that the use of G-CSF after ASCT is not associated with an increased risk of relapse. 39 The BEAM regimen has been recently advocated for T-cell ALL by the Russian ALL study group, 40 and treatment with TKI for Ph In vivo purging, MRD quantification and graft quality In the past decade numerous studies on adults and children with AML or ALL have reported that patients who achieve CR1, with no detectable MRD 41 evaluated after induction or conventional consolidation, have a significantly better outcome compared with MRD-positive patients. It is generally recommended that patients who are MRD-positive should be considered for allo-HSCT.…”