Work

Deferred Dosing of Granulocyte Colony Stimulating Factors in Autologous Hematopoietic Transplantation for Multiple Myeloma

Year: 2013

Type: article

Abstract: In autologous hematopoietic stem cell transplantation (ASCT), G-CSF administered from day +7 until ANC recovery, expedites ANC recovery and reduces days of hospitalization by 1-2 days. To determine whether delayed and abbreviated G-CSF dosage could produce equivalent ANC recovery and thereby improve cost effectiveness of ASCT for myeloma, we delayed administration of G-CSF until WBC recovery had begun and was ≥0.20/uL. G-CSF so administered was labeled deferred G-CSF dosing (DGD), Patients in the conventional dosing group (CGD) received daily doses of 5 mg/kg G-CSF beginning day +7. The primary and secondary end points are listed in table-1. The Institutional Review Board approved retrospective chart analysis A total of 117 patients with multiple myeloma received ASCT from January 2005 to September 2012. Of these, 65 patients received DGD and 52 received CGD. Patient, disease, and transplant-related variables were similar between 2 groups; patients in DGD received a larger dose of CD34+ cells/kg (median 4.49, range= 2.49-10.2 vs. median 3.79, range = 2.61-9.42, p= 0.021) The CGD group received a median of 5 doses of G-CSF, while the DGD group received, a median of 0 (range 0-5, P ≤ .0001) G-CSF doses (5μg/kg) when the WBC were a median of 1.18/uL (range 0.20/uL-2.54/uL) and the ANC a median of 158/uL (range 0-1168/uL); 36/65 (55%) patients in DGD received no G-CSF (at physician's discretion) and those who received the drug did so starting on day 14 (median) post-transplant (range =11d-18d). There was no difference in the incidence or duration of ≥ grade III mucositis, weight gain, rash or engraftment syndrome between DGD and CGD groups. However, as shown in Table 1 the CGD group had significantly faster engraftment, abbreviation of neutropenia, diminished antibiotics use, and shorter hospitalization. These effects were independent of CD 34 cell dose. Primarily because of abbreviated hospital stay, there was a 17% cost benefit to the use of CGD, supporting the overall benefit of this treatment regimen for patients with MM who receive ASCT.Table 1CharacteristicsCGD groupDGD groupP valueNeutrophil Engraftment (days)12 (11-14)15 (11-20)<0.0001Duration of neutropenia7 (5-9)10 (6-16)<0.0001(ANC <500)Duration of severe neutropenia6 (4-9)8 (4-10)<0.0001(ANC < 100) daysDuration of intravenous antibiotics5 (3-20)8 (3-15)0.016Duration of hospital stay17 (14-24)19 (16-28)<0.0001 Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2012.11.174