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Granulocyte-colony-stimulating factor after allogeneic and autologous bone marrow transplantation in children
U M Saarinen1, L Hovi, E Juvonen
1Children's Hospital, University of Helsinki, Finland.
Insights
Granulocyte colony-stimulating factor (G-CSF) significantly speeds up myeloid engraftment after pediatric allogeneic and autologous bone marrow transplants (BMT). G-CSF also reduced fever and antibiotic duration in autologous BMT patients.
Area of Science:
- Hematology
- Pediatric Oncology
- Stem Cell Transplantation
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various pediatric conditions.
- Myeloid engraftment, the recovery of neutrophil production post-BMT, is crucial for patient survival.
- Granulocyte colony-stimulating factor (G-CSF) is a growth factor that stimulates neutrophil production.
Purpose of the Study:
- To evaluate the efficacy of G-CSF in accelerating myeloid engraftment after allogeneic BMT (allo-BMT) and autologous BMT (ABMT) in children.
- To assess the impact of G-CSF on reducing febrile illness and antibiotic use in pediatric BMT patients.
Main Methods:
- Retrospective analysis of pediatric patients undergoing allo-BMT and ABMT.
- Comparison of patients who received G-CSF with historical control groups.
- G-CSF administered subcutaneously at 5 micrograms/kg/day until an absolute neutrophil count (ANC) of 1,000 x 10(6)/l was achieved.
Main Results:
- Following allo-BMT, G-CSF accelerated myeloid engraftment by 5 days at ANC 500 (P<0.02) and 9 days at ANC 1,000 (P<0.001).
- In ABMT patients, G-CSF accelerated myeloid engraftment by 6 days at ANC 200 (P<0.05), 11 days at ANC 500 (P<0.02), and 17 days at ANC 1,000 (P<0.005).
- ABMT patients receiving G-CSF experienced fewer days with fever and reduced antibiotic use.
Conclusions:
- G-CSF significantly accelerates myeloid engraftment in children undergoing both allo-BMT and ABMT.
- G-CSF administration can decrease the duration of febrile illness in pediatric ABMT patients.
- G-CSF is a valuable adjunct therapy for improving recovery post-pediatric BMT.
Abstract:
We evaluated the use of granulocyte CSF (G-CSF) after both allogeneic BMT (allo-BMT) and autologous BMT (ABMT) in children. After allo-BMT, G-CSF was used in 15 children who were compared with 20 historical controls. The ABMT patients were two sequential groups: the G-CSF group of 13 children and 11 historical controls. The patients were conditioned with different high-dose chemotherapy regimens with or without total body irradiation. G-CSF was administered at 5 micrograms/kg/day s.c. and was continued until an absolute neutrophil count (ANC) of 1,000 x 10(6)/l was reached. Following allo-BMT, G-CSF accelerated myeloid engraftment with a difference of 5 days at the ANC level of 500 x 10(6)/l (P<0.02) and 9 days at 1,000 x 10(6)/l (P<0.001). In the ABMT patients, G-CSF also accelerated myeloid engraftment. The difference between the G-CSF group and the control group was 6 days at ANC 200 (P<0.05), 11 days at ANC 500 (P<0.02) and 17 days at ANC 1,000 (P<0.005). In the ABMT patients, benefit by G-CSF was also observed in a smaller number of days with fever and days on antibiotics. We conclude that G-CSG significantly accelerated myeloid engraftment, after both allogeneic and autologous BMT in children, and also decreased the duration of febrile illness in the ABMT patients.