title: Administration of G-CSF from day +6 post-allogeneic hematopoietic stem cell transplantation in children and adolescents accelerates neutrophil engraftment but does not appear to have an impact on cost savings.
abstract: G-CSF post-allogeneic HSCT accelerates neutrophil engraftment, but evidence that it impacts on cost-related outcomes is lacking. We performed a retrospective child and adolescent single-center cohort study examining G-CSF administration from Day +6 of allogeneic HSCT vs. ad hoc G-CSF use where clinically indicated. Forty consecutive children and adolescents undergoing allogeneic HSCT were included. End-points were as follows: time to engraftment; incidence of acute and chronic GvHD; number of patients alive at Day +100; 180-day TRM; post-transplant days in hospital; and cost of antimicrobials, TPN, and G-CSF usage. Neutrophil engraftment occurred earlier in the group that received G-CSF from Day +6. There was no difference between groups in any of the other end-points with the following exception: the cost of GCSF was significantly higher in the D + 6 G-CSF group. However, median G-CSF cost in this group amounted to only €280. There was a trend towards reduced cost of antimicrobials in the D + 6 G-CSF group, although this did not reach significance (p = 0.13). The median cost per patient of antimicrobial agents between groups differed by €1116. This study demonstrated the administration of G-CSF on Day +6 in pediatric HSCT to be safe. A further study using a larger cohort of patients is warranted to ascertain its true clinico-economic value.
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Ciara
authors: C
authors: O'Rafferty
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Mairead
authors: M
authors: O'Brien
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Elaine
authors: E
authors: Smyth
authors: Department of Pharmacy, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Sinead
authors: S
authors: Keane
authors: Department of Dietetics, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Hillary
authors: H
authors: Robinson
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.
authors: Paul
authors: P
authors: Lynam
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.|Trinity College, Dublin, Ireland.
authors: Aengus
authors: A
authors: O'Marcaigh
authors: Department of Haematology, Our Lady's Children's Hospital, Dublin, Ireland.|Trinity College, Dublin, Ireland.
authors: Owen P
authors: OP
authors: Smith
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009504:Neutrophils / Q000166:cytology*; D010372:Pediatrics / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods
chemical_list: D000890:Anti-Infective Agents; D016179:Granulocyte Colony-Stimulating Factor
keywords: adolescents; children; growth factors; hematopoietic stem cell transplant; outcome