Granulocyte colony-stimulating factor for poor graft function after allogeneic stem cell transplantation: 3 days of G-CSF identifies long-term responders.
Poor graft function (PGF) is a frequent cause of morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). To study the value of granulocyte colony-stimulating factor (G-CSF) in PGF, we retrospectively analyzed 81 episodes of PGF in 66 patients transplanted from 01/94 to 01/99 from an HLA-identical sibling (n = 45) or an unrelated (n = 21) donor. Median age was 29 years, 55 patients had malignancies. A total of 11 patients received a CD34+ selected graft. Viral infections (25%), myelotoxic drug (33%), fungal/bacterial infections (14%), and GVHD (31%) were present before PGF diagnosis. Median time from allo-HSCT to PGF was 75 (25-474) days. All patients were treated with G-CSF. In 77/81 episodes, there was a response that was sustained in 57. A total of 27 patients presented an increase of white cell count (WBC) >0.1 x 10(9)/l after 3 days of G-CSF. The 5-year survival was 37% and was significantly better in patients with increased WBC > 0.1 x 10(9)/l after 3 days of G-CSF (65 vs 18%, P < 0.0001). In multivariate analysis, increased WBC > 0.1 x 10(9)/l after 3 days of G-CSF (P = 0.002) was associated with better survival, while BuCy-based conditioning (P = 0.02) and GVHD (P = 0.005) were associated with higher risk of death. In conclusion, hematological response after 3 days with G-CSF predicted a better survival for patients with PGF after allo-SCT.
Bone Marrow Transplant Unit, Hospital Saint-Louis, Paris, France.
H
H
Bittencourt
V
V
Rocha
A
A
Filion
I
I
Ionescu
A-L
AL
Herr
F
F
Garnier
L
L
Ades
H
H
Esperou
A
A
Devergie
P
P
Ribaud
G
G
Socie
E
E
Gluckman
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006086:Graft vs Host Disease / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000473:pathology; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D020127:Recovery of Function / Q000187:drug effects; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014777:Virus Diseases / Q000209:etiology / Q000401:mortality
D016179:Granulocyte Colony-Stimulating Factor