title: Treatment with granulocyte colony-stimulating factor after allogeneic bone marrow transplantation for acute leukemia increases the risk of graft-versus-host disease and death: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
abstract: OBJECTIVE
  Granulocyte colony-stimulating factor (G-CSF) is given after bone marrow transplantation (BMT) to shorten the neutropenic phase. Its effects have not been evaluated in a large patient population.
  
  
  METHODS
  We studied 1,789 patients with acute leukemia receiving BMT and 434 patients receiving peripheral-blood stem cells (PBSCs) from HLA-identical siblings from 1992 to 2002 and reported the findings to the European Group for Blood and Marrow Transplantation. Among the BMT and PBSC patients, 501 (28%) and 175 (40%), respectively, were treated with G-CSF during the first 14 days after the transplantation. The outcome variables were entered into a Cox proportional hazards model.
  
  
  RESULTS
  BMT and PBSC patients treated with G-CSF had a faster engraftment of absolute neutrophils greater than 0.5 x 10(9)/L (P <.01), but platelet engraftment ( > 50 x 10(9)/L) was slower (P <.001). In the BMT patients, acute graft-versus-host disease (GVHD) grades II to IV was 50% +/- 5% (+/- 95% CI) in the G-CSF group versus 39% +/- 3% in the controls (relative risk [RR], 1.33; P =.007, in the multivariate analysis). The incidence of chronic GVHD was also increased (RR, 1.29; P =.03). G-CSF was associated with an increase in transplantation-related mortality (TRM; RR, 1.73; P =.00016) and had no effect on relapse but reduced survival (RR, 0.59; P <.0001) and leukemia-free survival rates (LFS; RR, 0.64; P =.0003). No such effects of G-CSF were seen in patients receiving PBSC.
  
  
  CONCLUSIONS
  After BMT, platelet engraftment was delayed, and GVHD and TRM were increased. Survival and LFS were reduced. This suggests that G-CSF should not be given shortly after BMT.
authors.affiliation: Centre for Allogeneic Stem Cell Transplantation, Division of Clinical Immunology F79, Karolinska Institute, Huddinge University Hospital, SE-141 86 Stockholm, Sweden. Olle.Ringden@labmed.ki.se
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Norbert-Claude
authors.initials: NC
authors.lastname: Gorin
authors.forename: Katarina
authors.initials: K
authors.lastname: Le Blanc
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Jules
authors.initials: J
authors.lastname: Reiffers
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Jaak M
authors.initials: JM
authors.lastname: Vossen
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jouet
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Francesco
authors.initials: F
authors.lastname: Frassoni
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology*; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000627:therapeutic use; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D007223:Infant; D015479:Leukemia, Myelomonocytic, Acute / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000276:immunology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D016179:Granulocyte Colony-Stimulating Factor