Allogeneic Stem Cell And Stem Cell Transplantation Followed By Growth Factors

In the early posttransplant phase, neutropenia-associ-ated infectious complications are one of the most significant treatment-related toxicities. Infusions of primed peripheral blood progenitor cell and stem cell transplantations from HLA-matched siblings have shortened the duration of neutropenia. A benefit in terms of accelerated neutrophil recovery has been described in trials involving patients who were recipients of allogeneic peripheral blood progenitor cells and growth-factor support (G-CSF).56 In a subsequent randomized trial in T-cell depleted allogeneic blood progenitor recipients treated with or without posttransplantation growth factor support, there was no difference in the degree of immune reconstitution and no statistically significant difference in treatment outcome as measured by relapse, infections, or incidence of chronic graft versus host disease.57

Use of growth factors following allogeneic stem cell transplantation is not without side effects. There is a potential for delay in platelet recovery after using GM-CSF in the posttransplantation setting.58 A recent retrospective analysis suggested that recipients of stem cell transplantations should not receive G-CSF support in the immediate posttransplantation period. In the study, patients with acute myelogenous leukemia (1789 patients transplanted with HLA-matched sibling bone marrow and 434 patients transplanted with peripheral blood progenitor cells) were analyzed. Twenty-eight percent of bone marrow recipients and 40% of peripheral blood progenitor cell recipients received G-CSF during the first 2 weeks following transplantation.

While neutrophil recovery was faster, platelet engraftment did take longer, and the incidence of acute grades II-IV graft versus host disease was also higher (50% vs 39%, p = 0.007) in recipients of bone marrow who also received G-CSF support. The incidence of chronic graft versus host disease, as well as transplant-related mortality and leukemia-free and overall survival were also adversely affected. No such adverse effects were noted in recipients of peripheral blood progenitor cells regardless of whether they received growth factor support.59

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