Granulocyte colony-stimulating factor induced acute and chronic graft-versus-host disease.
BACKGROUND
A recent experimental study in mice shed new light on the controversy as to whether granulocyte colony-stimulating factor (G-CSF) increases graft-versus-host disease (GVHD). Total body irradiation and bone marrow were found to be prerequisites for acute GVHD. This study encouraged us to perform a retrospective clinical study.


METHODS
We compared 260 patients given G-CSF prophylaxis after allogeneic hematopoietic stem-cell transplantation with 205 controls transplanted between 1993 and 2003.


RESULTS
G-CSF hastened the engraftment of neutrophils, but that of platelets was delayed (P<0.0001). The proportion of acute GVHD of grades II to IV was 29% in the G-CSF group and 19% in the controls (P<0.01) and that of chronic GVHD was 54% and 43%, respectively (P=0.019). G-CSF increased acute and chronic GVHD in patients preferentially conditioned with chemotherapy. Unexpectedly, it exacerbated acute GVHD in recipients of peripheral blood stem cells and enhanced chronic GVHD in bone marrow recipients. A multivariable analysis showed that acute GVHD (hazards ratio=1.52, P=0.03) and chronic GVHD (hazards ratio=1.51, P=0.004) were associated with G-CSF. There was no significant difference between study groups regarding nonrelapse mortality, relapse, or survival.


CONCLUSIONS
G-CSF increased acute and chronic GVHD in patients treated with chemotherapy but did not affect relapse or survival.
Ringden
Olle
O
Division of Clinical Immunology, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden. Olle.Ringden@ki.se
Hassan
Zuzana
Z
Karlsson
Helen
H
Olsson
Richard
R
Omazic
Brigitta
B
Mattsson
Jonas
J
Remberger
Mats
M
D000017:ABO Blood-Group System; D000208:Acute Disease; D000818:Animals; D016470:Bacteremia / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000139:chemically induced* / Q000453:epidemiology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D051379:Mice; D010976:Platelet Count; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
D000017:ABO Blood-Group System; D016179:Granulocyte Colony-Stimulating Factor