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Granulocyte colony-stimulating factor for poor graft function after allogeneic stem cell transplantation: 3 days of
H Bittencourt1, V Rocha, A Filion
1Bone Marrow Transplant Unit, Hospital Saint-Louis, Paris, France.
Insights
Granulocyte colony-stimulating factor (G-CSF) treatment shows promise for poor graft function (PGF) after allogeneic stem cell transplant. Early white blood cell count increase predicts better survival in PGF patients.
Area of Science:
- Hematology
- Transplantation Immunology
Background:
- Poor graft function (PGF) is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- Identifying predictive markers for treatment response in PGF is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of granulocyte colony-stimulating factor (G-CSF) in managing PGF after allo-HSCT.
- To determine if early hematological response to G-CSF predicts survival in patients with PGF.
Main Methods:
- Retrospective analysis of 81 PGF episodes in 66 patients undergoing allo-HSCT between 1994 and 1999.
- Patients received G-CSF treatment for PGF; early increase in white blood cell count (WBC) (>0.1 x 10(9)/l) after 3 days was assessed.
- Survival rates were compared based on early WBC response and other clinical factors.
Main Results:
- G-CSF treatment led to a sustained response in 57 out of 81 PGF episodes.
- A significant increase in WBC (>0.1 x 10(9)/l) after 3 days of G-CSF was observed in 27 patients.
- Five-year survival was 37% overall, but significantly higher (65% vs 18%) in patients with an early WBC response to G-CSF.
Conclusions:
- Early hematological response, specifically an increase in WBC after 3 days of G-CSF, is a strong predictor of improved survival in patients with PGF post-allo-SCT.
- G-CSF is effective in managing PGF, and monitoring early response can guide therapeutic decisions.
- BuCy conditioning and GVHD were identified as risk factors for mortality in this patient cohort.
Abstract:
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.
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