The effect of macrophage colony-stimulating factor on haemopoietic recovery after autologous bone marrow transplantation.
Macrophage colony-stimulating factor (M-CSF) is active in the late stages of monocyte maturation, activates mature monocyte-macrophages and enhances their production of various other cytokines. We have examined the effects of a 21 d course of escalating doses of M-CSF purified from human urine (hM-CSF) on recovery following autologous bone marrow transplantation (ABMT) in 20 patients with malignant lymphomas. Four patients were treated at each dose level of 4, 8, 16, 32 and 64 x 10(6) U/m2/d and results compared to 46 concurrent controls. There was no significant difference in recovery to an absolute neutrophil count (ANC) of 0.5 x 10(9)/l (median 20 d in hM-CSF group versus 22 in controls) or in recovery of platelets to 50 x 10(9)/l (32 d versus 39 d, 0.05 less than P less than 0.1); hM-CSF patients received a median of 81 platelet units following ABMT (controls 112 units, P = NS). hM-CSF patients had a median of 5.5 d with fever greater than 37.5 degrees C (control 8, P = NS), received parenteral antibiotics for 14.5 d (control 17, P = NS) and had a 50% incidence of bacteraemia (control 48%). hM-CSF treated patients were discharged by a median of day 29 following transplantation (control 33, P less than 0.05). Platelet and neutrophil recovery correlated significantly with the number of marrow mononuclear cells (MNC) reinfused in the hM-CSF group (P = 0.05 and P = 0.014 respectively) but not in controls. Subgroup analysis showed that hM-CSF patients receiving greater than 2 x 10(8) MNC/kg body weight reached an ANC of 0.5 x 10(9)/l by a median of day 16.5 (control 18.5, NS), became platelet transfusion independent by day 17 (control 29, P less than 0.05) and reached a platelet count of 50 x 10(9)/l by day 21 (control 40, P less than 0.05). No significant toxicity attributable to hM-CSF treatment was seen. These results suggest that hM-CSF accelerates platelet recovery following ABMT and that relatively large marrow innocula are required to see this effect.
Khwaja
A
A
Department of Haematology, University College and Middlesex School of Medicine, London, U.K.
Yong
K
K
Jones
H M
HM
Chopra
R
R
McMillan
A K
AK
Goldstone
A H
AH
Patterson
K G
KG
Matheson
C
C
Ruthven
K
K
Abramson
S B
SB
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D006689:Hodgkin Disease / Q000097:blood* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000401:mortality / Q000628:therapy; D016173:Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D010976:Platelet Count
D016173:Macrophage Colony-Stimulating Factor