The combination of erythropoietin and granulocyte colony‐stimulating factor increases the rate of haemopoietic recovery with clinical benefit after peripheral blood progenitor cell transplantation

Abstract

In order to investigate the effects of erythropoietin (EPO) plus granulocyte colony-stimulating factor (G-CSF) administration after peripheral blood progenitor cell transplantation (PBPCT) we performed a phase I/II study in patients with high-risk cancer. 15 consecutive patients were treated wit recombinant human G-CSF (rhG-CSF) at the dose of 5 micrograms/kg subcutaneously (s.c.) every 24 h until day + 12 and with recombinant human EPO (rhEPO) at the dose of 150 IU/kg s.c. every 48 h until day + 11 following PBPCT. Their haemopoietic recovery was compared to that obtained in eight historic and control patients who did not receive any cytokines after PBPCT. No side-effects were observed during EPO plus G-CSF treatment and the treatment was not discontinued in any of the patients before completion of the treatment plan. The administration of EPO plus G-CSF after PBPCT produced a significant increase in the rate of white blood cell (WBC) (P = 0.0005), polymorphonuclear leucocyte (PMN) (P = 0.0005) and platelet (PLT) (P = 0.0105) recovery compared to the control group. The acceleration in haemopoietic recovery observed in the EPO plus G-CSF-treated patients produced a significant reduction of the days with WBC < 1 x 10(9)/l (P = 0.0009), PMN < 0.2 x 10(9)/l (P = 0.0030) and PMN < 0.5 x 10(9)/l (P = 0.0006). EPO plus G-CSF-treated patients required a significantly lower number of single donor PLT transfusions (P = 0.0142) and did not experience neutropenic fever, but historic control patients experienced fever > 38 degrees C for a median period of 4 d (0-12) with a medial period of parenteral antibiotic administration of 7.5 d (0-17). The length of the hospital stay was significantly shorter in the study group than in the historic control group (P = 0.0264). In conclusion, we can confirm that EPO plus G-CSF treatment is feasible and potentiates the haemopoietic recovery after PBPCT, thus simplifying the clinical management of cancer patients who undergo high-dose chemotherapy.

Optimization of recombinant human erythropoietin therapy after allogeneic hematopoietic stem cell transplantation

“…Median time to 1% reticulocytes was 12 days (range [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] in the study group vs 27 days (range 13-72) in the control group ( p ϭ 0.0177). Neutrophil and platelet engraftments were not different.…”

“…transfusion requirements after autologous HSCT [16][17][18][19][20][21][22]. In contrast, clinical trials of rhEpo therapy after allogeneic bone marrow transplantation (BMT) resulted in accelerated erythroid engraftment and some reduction in transfusion requirements [17,18,[23][24][25][26][27][28][29][30].…”

Successful autologous peripheral blood stem cell transplantation in a Jehovah’s Witness with multiple myeloma: review of literature and recommendations for high-dose chemotherapy without support of allogeneic blood products

“…Indeed, several publications have indicated an advantage in favour of the usage of EPO after transplantation. Pirelli et al [9] found evidence in a phase I/II study, compared to historical controls, that the combination of G-CSF (5 lg/kg s.c.) and EPO (150 I.U./kg s.c., every 48 days) after transplantation of peripheral blood stem cells might be superior to the single therapy with respect to recovery of white blood cells Table 1 Eligibility criteria and contraindications for allogeneic transfusion-free autologous peripheral blood stem cell transplantation and platelets. Therefore, we decided to use a combination of the mentioned regimen with a fixed [10] dose of 4,000 I.U.…”

rhEPO in hematopoietic stem cell transplantation

“…Consequently, the number of platelet transfusions was not different nor was the number of RBC transfusions between day 0 and 35 (10 ± 3 vs 10 ± 7) or after day 35 (5 ± 7 vs 8 ± 12). Pierelli et al (1996) gave rhEPO (150 U/kg SC every 48 hours, days 1-11) and G-CSF (5 μg/kg/d SC, days 1-12) to 15 patients with breast or ovarian carcinoma undergoing intensive chemotherapy followed by peripheral blood stem cell support. Compared to 8 historical controls, neutrophil and platelet engraftments were accelerated and the number of platelet transfusions was reduced, but there was no effect on erythroid recovery.…”