Revisiting G-CSF Support for Hematologic Recovery after Autologous Transplantation in AML Patients
Publisher DOI
Abstract
In acute myeloid leukemia (AML) patients, using granulocyte colony-stimulating
factor (G-CSF) to support hematologic recovery in induction
and consolidation treatment reduces the number of febrile episodes and the
duration of neutropenia and hospitalization. However, the benefit and safety of
administering G-CSF to enhance hematologic recovery in AML patients after
autologous stem cell transplantation (ASCT) have not been reported so far. At
our center, it was our policy to administer G-CSF after ASCT in all AML patients.
In June 2015, increasing economic pressure prompted us to omit G-CSF after
ASCT. In this retrospective study, we assessed the effects of changing our
strategy from applying G-CSF for hematologic recovery after ASCT (in 103
AML patients) to omitting G-CSF (12 patients). We found that administering
G-CSF shortened the median duration until neutrophil recovery was >0.5 G/l
after ASCT by four days (P=.0001), and patients with G-CSF tended to have
fewer bacteremias (38.3% versus 66.6%; P=.0654). The median duration of
hospitalization was two days longer in patients without G-CSF support (25
versus 23 days; P=.0603). According to the Swiss in-patient reimbursement
system, the shorter hospitalization of +G-CSF patients resulted in decreased
total costs per patient of 3305 CHF (48 Mio U of G-CSF), and 3367 CHF (30 Mio
U). Finally, no differences were observed in disease free (P=.0938) and overall
survival (P=.7999) rates between +G-CSF versus –G-CSF patients. Our data
suggest that G-CSF support after ASCT is safe and associated with shorter time
until neutrophil recovery, fewer bacteremia episodes, shorter hospitalization,
and lower costs.
Keywords: Autologous; Transplant; AML; Leukemia; Recovery; Prognosis;
Survival; Granulocyte-colony Stimulating factor; G-CSF; Consolidation
factor (G-CSF) to support hematologic recovery in induction
and consolidation treatment reduces the number of febrile episodes and the
duration of neutropenia and hospitalization. However, the benefit and safety of
administering G-CSF to enhance hematologic recovery in AML patients after
autologous stem cell transplantation (ASCT) have not been reported so far. At
our center, it was our policy to administer G-CSF after ASCT in all AML patients.
In June 2015, increasing economic pressure prompted us to omit G-CSF after
ASCT. In this retrospective study, we assessed the effects of changing our
strategy from applying G-CSF for hematologic recovery after ASCT (in 103
AML patients) to omitting G-CSF (12 patients). We found that administering
G-CSF shortened the median duration until neutrophil recovery was >0.5 G/l
after ASCT by four days (P=.0001), and patients with G-CSF tended to have
fewer bacteremias (38.3% versus 66.6%; P=.0654). The median duration of
hospitalization was two days longer in patients without G-CSF support (25
versus 23 days; P=.0603). According to the Swiss in-patient reimbursement
system, the shorter hospitalization of +G-CSF patients resulted in decreased
total costs per patient of 3305 CHF (48 Mio U of G-CSF), and 3367 CHF (30 Mio
U). Finally, no differences were observed in disease free (P=.0938) and overall
survival (P=.7999) rates between +G-CSF versus –G-CSF patients. Our data
suggest that G-CSF support after ASCT is safe and associated with shorter time
until neutrophil recovery, fewer bacteremia episodes, shorter hospitalization,
and lower costs.
Keywords: Autologous; Transplant; AML; Leukemia; Recovery; Prognosis;
Survival; Granulocyte-colony Stimulating factor; G-CSF; Consolidation
Date Issued
2017-04-26
Publication Type
Article
Language(s)
en
Author(s)
Oberson, JS | |
Baerlocher, Gabriela M. | |
Mueller, BU |
Journal
Annals of Hematology & Oncology
Publisher
Austin Publishing Group
ISSN
2375-7965
Access(Rights)
restricted