Work

Initiation of Colony Stimulation Factors Following Autologous Hematopoietic Stem Cell Transplant: Do 2 Days Really Matter?

Year: 2025

Type: article

Abstract: Topic Significance & Study Purpose/Background/Rationale The use of granulocyte colony-stimulating factor (GCSF) has been shown to reduce the duration of neutropenia , neutropenic related sequelae , and hospital length of stay (LOS) after autologous hematopoietic stem cell transplant (ASCT), but there is no clear standard as to when to initiate GCSF post-transplant. In an effort to reduce LOS, our institution changed the initiation of GCSF from day +7 to day +5. Here we evaluate the outcomes of GCSF initiated on day +5 compared with day +7 in patients undergoing ASCT, with BEAM or Melphalan conditioning. Methods, Intervention, & Analysis A retrospective Quality Assurance/Quality Improvement review was conducted of all patients, age 18 or older, who received BEAM or Melphalan conditioning followed by an ASCT at our institution between March 1, 2023, and February 29, 2024. The initiation of GCSF changed from day +7 to day +5 on September 1, 2024. Patients were included in the final analysis if they were alive at day +30. Outcomes included LOS, duration of Grade 4 neutropenia , incidence of blood stream infections (BSI), incidence of intravenous antibiotic administration, and number of GCSF doses administered. Findings & Interpretation Initiation of GCSF was administered to 85 patients on day +5 and 91 on day +7 (Table 1). Age, gender, and conditioning regimens were similar between the 2 groups. LOS, duration of Grade 4 neutropenia, incidence of febrile neutropenia , incidence of positive BSI, and administration of intravenous antibiotics did not differ between the day +5 and +7 groups. The median number of GCSF doses were significantly higher in the day +5 group (9 vs 7; p≤0.001). In a subgroup analysis, outcomes did not differ between conditioning regimens. Discussion & Implications Initiating GCSF 2 days earlier in this patient population did not significantly impact LOS, duration of Grade 4 neutropenia, febrile neutropenia , incidence of blood stream infections , or administration of IV antibiotics. Larger, prospective trials are needed to determine when best to initiate GCSF.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.713