G‐CSF after PBSC transplantation

Ojeda, Emilio; Garcia-Bustos, J.; Mj, Aguado; Luaces, M Rodríguez; Arrieta, R; Hernandez‐Navarro,

doi:10.1046/j.1365-2141.1998.0778c.x

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Some recent data showed that G-CSF could be safely delayed after PBPCT resulting in a reduction of drug exposure and cost savings without compromising haemopoietic recovery. 15,19,20 Little is known about the use of G-CSF after immunoselected CD34 ϩ aPBPCT. In this setting the procedure virtually abrogates the early haemopoietic recovery due to the abundance of committed progenitors in the leukapheresis product and a delay in the haemopoietic recovery is thus expected.…”

Section: Discussionmentioning

confidence: 99%

“…This observation is in contrast to what is observed after unmanipulated PBPCT. 15,20 We also performed G-CSF serum level assays during PBSCT to recognize the entity and the behaviour of the endogenous production of G-CSF levels after CD34 ϩ PBPCT and the serum level achievable when exogenous G-CSF is administered at a standard dose of 263 g/day from day ϩ1 or from day ϩ7. The endogenous G-CSF serum level was consistently lower in patients after CD34 ϩ PBPCT not receiving this growth factor compared to patients submitted to unfractionated PBPCT, 16 thus resulting in an inappropriate G-CSF production in response to neutropenia after CD34 ϩ PBPCT and providing a strong rationale for G-CSF support.…”

Section: Discussionmentioning

confidence: 99%

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Optimal timing of G-CSF administration after CD34+immunoselected peripheral blood progenitor cell transplantation

Piccirillo

Sica

Laurenti

et al. 1999

Bone Marrow Transplant

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Summary:G-CSF accelerates neutrophil recovery after autologous peripheral blood progenitor cell transplantation (aPBPCT), although the optimal timing for its administration is currently unknown. In order to establish the role and the optimal timing of administration of G-CSF after immunoselected CD34 ؉ aPBPCT, we analyzed the data from 21 consecutive patients affected by haematological malignancies. Patients were randomized into three groups according to G-CSF administration after transplantation: day ؉1 (group B); day ؉7 (group C) or no G-CSF (group A). Serum G-CSF level was evaluated until engraftment. The CD34 ؉ cell dose reinfused was similar (P = 0.48). G-CSF significantly reduced time to recovery of PMN Ͼ0.5 × 10 9 /l (11 vs 14 vs 20.5 days) (P = 0.00046); Ͼ1.0 × 10 9 /l (12 vs 15 vs 22) (P = 0.001). No difference was observed in the number of days with PMN Ͻ0.1 × 10 9 /l (5.5 vs 7 vs 8 days). Platelet count Ͼ50 × 10 9 /l and Ͼ100 × 10 9 /l, reticulocytes Ͼ1%, length of hospitalization, non-prophylactic antibiotic therapy, fever, incidence of sepsis and transfusion support did not differ. Early or delayed G-CSF after immunoselected CD34 ؉ aPBPCT significantly accelerated PMN recovery but did not reduce the amount of supportive treatment or the duration of hospitalization. Delaying the initiation of G-CSF did not reduce the length of treatment (11.5 vs 12 days). Early or delayed G-CSF administration resulted in G-CSF peak serum levels 7 (early)-12 (delayed)-fold greater than an endogenous response to neutropenia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimal timing of G-CSF administration after CD34+immunoselected peripheral blood progenitor cell transplantation

Piccirillo

Sica

Laurenti

et al. 1999

Bone Marrow Transplant

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“…The day of initiation was decided after a previous randomized study in our centre demonstrated that the results of delayed administration were similar to those of early filgrastim administration (reported by others). 11,12 The control group received no colony-stimulating factors.…”

Section: Clinical Management and Support Measuresmentioning

confidence: 99%

A prospective randomized trial of granulocyte colony-stimulating factor therapy after autologous blood stem cell transplantation in adults

Ojeda

Garcia-Bustos

et al. 1999

Bone Marrow Transplant

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Summary:In order to assess the potential clinical benefit of filgrastim (G-CSF) after peripheral blood stem cell (PBSC) autotransplantation a randomized study was begun in our center in July 1997: 62 patients were involved (30 received filgrastim after PBSC infusion and 32, the control group, received no cytokines). All were adults (median 40 years, range 18-65). Patients with one of three different pathologies were recruited: 28 had advanced breast carcinoma, 23 had lymphomas (12 Hodgkin's disease and 11 non-Hodgkin's lymphoma) and 11 had de novo AML. All of them were transplanted using myeloablative chemotherapy conditioning regimens. G-CSF was administered subcutaneously from day +5 in the treated group at a dose of 5 g/kg body weight/day. The numbers of CD34 + and mononuclear (MNC) cells infused were similar in each group. Only minor differences regarding the use of G-CSF could be inferred from the analysis of the data. Faster granulocyte engraftment was evident in the treated group (mean of 10 vs 12 days to achieve Ͼ0.5 × 10 9 /l granulocytes, P = 0.0008), without differences in incidence and severity of infections, days of fever or duration of antibiotic treatment between groups. There was slightly slower platelet engraftment (mean of 15 days in the group with G-CSF vs 12 days in the other group to achieve Ͼ20 × 10 9 /l platelets, P = NS) in this series, but there were no differences in incidence and severity of haemorrhage or platelet transfusion support. Considering the economical costs, the median expenditure per inpatient stay was Eur5961 (range Eur4386-Eur17186) in the G-CSF group compared with Eur5751 (range Eur3676-Eur15640) in the control group (P = 0.47). From our data it could be concluded that for adult patients transplanted with PBSC there is no clear beneficial impact of post-infusion G-CSF administration.

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“…Using G-CSF postinfusion in patients undergoing PBSCT is a controversial issue [6,12,13]. However, it appears to be evident that it shortens the neutropenia period.…”

Section: Discussionmentioning

confidence: 99%

Autologous peripheral blood stem cell transplant in patients previously diagnosed with invasive aspergillosis

Sevilla

Hernández‐Maraver

et al. 2001

Annals of Hematology

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Patients previously diagnosed with invasive aspergillosis (IA) have been considered to be at risk for relapse of mycosis during subsequent hematopoietic transplant. Even with prophylactic measures, reactivation of the infection occurs in 29% of patients undergoing bone marrow transplantation (BMT). A period of neutropenia is one of the variables considered to be a risk factor for reactivation. Peripheral blood stem cell transplant (PBSCT) results in a shorter neutropenia period leading to a lower risk of fungal infection. A retrospective data analysis performed on patients undergoing autologous PBSCT for hematological malignancies in our unit showed that nine patients were diagnosed before transplantation with IA. All patients received only medical treatment during their primary infection. Medical prophylaxis was administered in seven of these patients, and two underwent transplantation without prophylaxis. All patients developed severe neutropenia after a myeloablative regimen. All but one had neutropenic fever, although the fever was controlled and no fungal complications occurred. All patients in this series achieved complete hematological engraftment without delay in granulocyte recovery (mean: 8.78 vs 9.76; p=0.58). No significant differences were observed in toxicities with regards to transplantation between patients previously diagnosed with IA and their controls. Recurrence of IA related to transplantation was avoided since no relapse of IA was demonstrated. This series of nine patients with a previous history of IA shows that medical treatment, secondary prophylaxis, and peripheral blood as a source of stem cells could be effective measures to avoid reactivation of previous aspergillosis during hematopoietic transplantation, although prospective randomized trials should still be performed to confirm these findings in a wider setting.

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G‐CSF after PBSC transplantation

Cited by 4 publications

References 3 publications

Optimal timing of G-CSF administration after CD34+immunoselected peripheral blood progenitor cell transplantation

Optimal timing of G-CSF administration after CD34+immunoselected peripheral blood progenitor cell transplantation

A prospective randomized trial of granulocyte colony-stimulating factor therapy after autologous blood stem cell transplantation in adults

Autologous peripheral blood stem cell transplant in patients previously diagnosed with invasive aspergillosis

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