Randomized study of growth factors post-peripheral-blood stem-cell transplant: neutrophil recovery is improved with modest clinical benefit.

Abstract

Despite faster neutrophil recovery and shortened duration of hospitalization with GFs administered after PBSC transplantation, the measured clinical variables of febrile days, septic episodes, and transfusion requirements were similar between the study arms. The use of GFs post-PBSC transfusion is associated with a modest clinical benefit.

High-dose carboplatin, etoposide and melphalan (CEM) with peripheral blood progenitor cell support as late intensification for high-risk cancer: non-haematological, haematological toxicities and role of growth factor administration

“…Most of the patients did not require RBC transfusion and patients treated with growth factors after PBPCT had a less marked decline of Hb levels than patients treated with PBPCT only (Figure 1). The administration of EPO with G-CSF and GM-CSF after PBPCT probably abrogated the previously described detrimental effect of G-CSF and GM-CSF on PLT recovery after PBPCT (Spitzer et al, 1994;Shimazaki et al, 1994;Bensinger et al, 1994), which could be caused by a prevalent potentiation of myelopoiesis with a consensual progenitor cell competition in vivo. Patients treated with growth factors did not require systemic antibiotic therapy with the total abrogation of neutropenic fever in G-CSF plus EPO-treated patients, while GM-CSF plus EPO-treated patients experienced only episodes of intermittent hyperthermia, which did not meet the criteria for the start of systemic antibiotic treatment.…”

“…In terms of non-haematological toxicity, these results are similar to or better than those reported elsewhere for other combinations of high-dose alkylating agents with progenitor cell support in combination or not with etoposide (Williams et al, 1987;Gaspard et al, 1988;Slease et al, 1988;Vincent et al, 1988;Eder et al, 1990;Elias et al, 1991;Williams et al, 1992;Siegert et al, 1994;Benedetti Panici et al, 1995). Our results are better in terms of non-haematological toxicity than those reported recently for patients with high-risk cancer treated with ifosfamide, carboplatin and etoposide (Barnett et al, 1993;Fields et al, 1994;Elias et al, 1995), high-dose cyclophosphamide and etoposide (de Graaf et al, 1994), high-dose cyclophosphamide and carboplatin (Spitzer et al, 1995) , the quality of the graft collected in these patients, most of whom were chemotherapy-naive at the time of PBPC mobilization and collection, made it possible to obtain an accelerated haematopoietic recovery in most patients, faster than that reported in several other experiences of PBPC transplantation (Gianni et al, 1989;Menichella et al, 1991;Elias et al, 1992;To et al, 1992;Henon et al, 1992;Sheridan et al, 1992;Peters et al, 1993b;Sica et al, 1993;Chao et al, 1993;Bensinger et al, 1993;Pierelli et al, 1994;Spitzer et al, 1994;Shimazaki et al, 1994;Bishop et al, 1994). The present study also shows that a significantly faster WBC, PMN and PLT recovery can be achieved by administering G-CSF plus EPO after PBPCT, as described previously (Pierelli et al, 1996).…”

“…Only one patient in the present study experienced a microbiologically documented infection (Candida glabrata) and she belonged to the group of patients treated with PBPCs only. The reduction of haematological toxicity in our series and particularly in G-CSF plus EPO-and GM-CSF plus EPO-treated patients translated into a global simplification of the patients' clinical management with a significant reduction of hospital stay compared with several other studies on PBPCT (Gianni et al, 1989;Menichella et al, 1991;Elias et al, 1992;Henon et al, 1992;Sheridan et al, 1992;To et al, 1992;Bensinger et al, 1993;Chao et al, 1993;Peters et al, 1993b;Sica et al, 1993;Pierelli et al, 1994;Shimazaki et al, 1994;Spitzer et al, 1994;Bishop et al, 1994). None of the patients died early of CEM plus PBPCT-related complications and this is one of the best results reported in high-dose treatment with haematopoietic support.…”

Comparison between filgrastim and lenograstim plus chemotherapy for mobilization of PBPCs

“…4 However, the use of G-CSF after autologous PBPC transplantation has been queried, as its further reduction in time to a safe neutrophil count 5,6 does not always imply fewer significant clinical events, such as infections, length of hospitalization, extrahematological toxicities or mortality. 7,8 Even so, the ASCO guidelines still recommend the use of growth factors after autologous PBPC transplantation. 9 G-CSF induces the proliferation and differentiation of myeloid precursor cells, and also provides a functional activity that influences chemotaxis, respiratory burst and Ag expression of neutrophils.…”

SCT in Jehovah's Witnesses: the bloodless transplant

“…37,38 The data for platelet and erythroid growth factors are less definitive. IL-11 is a growth factor that increases platelet production.…”