Recombinant human granulocyte colony-stimulating factor (rh-G-CSF) may accelerate hematopoietic recovery after HLA-identical sibling allogeneic peripheral blood stem cell transplantation

We studied the effects of recombinant human granulocyte colony-stimulating factor (G-CSF) on hematopoietic recovery and clinical outcome in patients undergoing allogeneic peripheral blood stem cell (PBSC) transplantation. Fifty-six patients with hematological malignancies who underwent allogeneic PBSC transplantation between 1995 and 1998 were entered into this study. Twenty-eight patients who received daily G-CSF from day +1 after allogeneic PBSC transplantation until the absolute neutrophil count (ANC) reached >0.5 × 10⁹/l for 3 consecutive days were compared with 28 patients (control group) who did not receive G-CSF in a non-randomized manner. The study group and the control group were comparable with respect to baseline patient and transplantation characteristics. Median times to ANC of >0.5 × 10⁹/l and 1 × 10⁹/l with or without G-CSF were 12 days (range 8-21), 13 days (10-32) (P=0.04) and 13 days (9-21), 15 days (11-44) (P=0.02), respectively. Median times to reach a platelet count of >20 × 10⁹/l with and without G-CSF were 11 days (0-20) and 13 days (9-26), respectively (P=0.03). The incidence of febrile episodes was significantly lower with G-CSF, 75% vs 100% (P=0.008). Patients receiving G-CSF had less grade III-IV mucositis than those who did not receive G-CSF (P=0.01). There was also no increase in the incidence and severity of acute GVHD in patients using G-CSF (P=0.22). Although the number of relapsing patients was greater in the G-CSF group (seven vs three patients), this was not statistically significant (P=0.24). Disease-free and overall survival rates did not differ between the two groups (P=0.58 and 0.53, respectively). The administration of G-CSF after allogeneic PBSC transplantation provided faster neutrophil and platelet engraftment associated with less severe mucositis and less febrile episodes.