Treatment with granulocyte colony-stimulating factor after allogeneic bone marrow transplantation for acute leukemia increases the risk of graft-versus-host disease and death: A study from the acute leukemia working party of the European group for blood and marrow transplantation

Olle Ringdén, Myriam Labopin, Norbert Claude Gorin, Katarina Le Blanc, Vanderson Rocha, Eliane Gluckman, Jules Reiffers, William Arcese, Jaak M. Vossen, Jean Pierre Jouet, Catherine Cordonnier, Francesco Frassoni

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Granulocyte colony-stimulating factor (G-CSF) is given after bone marrow transplantation (BMT) to shorten the neutropenic phase. Its effects have not been evaluated in a large patient population. Patients and Methods: We studied 1,789 patients with acute leukemia receiving BMT and 434 patients receiving peripheral-blood stem cells (PBSCs) from HLA-identical siblings from 1992 to 2002 and reported the findings to the European Group for Blood and Marrow Transplantation. Among the BMT and PBSC patients, 501 (28%) and 175 (40%). respectively, were treated with G-CSF during the first 14 days after the transplantation. The outcome variables were entered into a Cox proportional hazards model. Results: BMT and PBSC patients treated with G-CSF had a faster engraftment of absolute neutrophils greater than 0.5 × 109/L (P <.01), but platelet engraftment (> 50 × 109/L) was slower (P <.001). In the BMT patients, acute graft-versus-host disease (GVHD) grades II to IV was 50% ± 5% (± 95% CI) in the G-CSF group versus 39% ± 3% in the controls (relative risk [RR], 1.33; P = .007, in the multivariate analysis). The incidence of chronic GVHD was also increased (RR, 1.29; P = .03). G-CSF was associated with an increase in transplantation-related mortality (TRM; RR, 1.73; P = .00016) and had no effect on relapse but reduced survival (RR, 0.59; P <.0001) and leukemia-free survival rates (LFS; RR, 0.64; P = .0003). No such effects of G-CSF were seen in patients receiving PBSC. Conclusion: After BMT, platelet engraftment was delayed, and GVHD and TRM were increased. Survival and LFS were reduced. This suggests that G-CSF should not be given shortly after BMT.

Original languageEnglish
Pages (from-to)416-423
Number of pages8
JournalJournal of Clinical Oncology
Volume22
Issue number3
DOIs
Publication statusPublished - 2004

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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