Effects of G-CSF vs. No G-CSF on Outcomes Post-Autologous Stem Cell Transplant - A Two-Centre Retrospective Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5133-5133
Author(s):  
Debra J. Bergstrom ◽  
Wanda S. Hasegawa ◽  
Peter Duggan
Keyword(s):  
Stem Cell ◽  
Febrile Neutropenia ◽  
Hospital Discharge ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Post Transplant ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Neutrophil Engraftment

Abstract INTRODUCTION In management of patients post-autologous stem cell transplant (ASCT), there continues to be controversy regarding the benefit of granulocyte-colony stimulating factor (GCSF) given post-autologous stem cell transplantation on length of time to engraftment and rates of febrile neutropenia. We conducted a chart review on all patients who received autologous stem cell transplants with follow-up at two tertiary care centres, the Health Sciences Centre in St. John’s, Newfoundland, and Victoria General Hospital in Halifax, Nova Scotia from February 2001 to February 2006. METHODS Comparison was made between two groups, either receiving (Group A) or not receiving (Group B) planned GCSF (starting 5 days post ASCT) for engraftment purposes. Patients who were not intended to receive GCSF but later received it due to delayed engraftment or febrile neutropenia remained in the non-intervention arm for analysis. Patients were excluded who had CD34+ infusion doses of < 2.5 cells x 106/kg body weight as all these patients received planned GCSF to promote engraftment at both centers. Also, we excluded patients who were transferred from the treatment center (Halifax or St. John’s) to their referring center for post transplant care prior to engraftment as follow up data would not be available for these cases. Primary outcomes included time to neutrophil engraftment and days to hospital discharge. Secondary outcomes included episodes of febrile neutropenia, number of packed red cell and platelet transfusions, days to platelet engraftment and transplant related mortality. Comparison between groups of episodes of febrile neutropenia was performed using Fisher’s exact test and all other variables were analyzed using the unpaired t-test. RESULTS 215 patients were included, having received autologous stem cell transplants at the above centres from February 2001 to February 2006. There were no significant differences between the two groups in age, sex, or diagnoses. More patients in Group B received etoposide/melphalan conditioning whereas there were more treated with BEAM in group A. Mobilizing regimens also differed significantly, with more patients in the group B receiving GCSF alone. Median time to neutrophil engraftment differed between group A and group B (11 vs. 14 days respectively, p<0.0001). There was a higher incidence of febrile neutropenia in patients in group B (89%) compared with group A (76%, p<0.01). However, there was no significant difference between days to hospital discharge, platelet and packed red cell transfusions, or transplant related mortality. One distinct weakness of the study was in evaluating the duration of hospital stay as this was determined by date of final discharge post transplant and did not take into account delayed admissions or periods of discharge between recurrent admissions for transplant-related issues. CONCLUSION We observed a significant difference between the rate of febrile neutropenia and duration to neutrophil engraftment in those routinely receiving GCSF as part of post-transplant care vs. those who receive it either not at all or only for delayed engraftment. However, the clinical significance of these findings is unclear, particularly as the time to hospital discharge and the transfusion requirement was the same between the groups. Nonetheless, these results indicate a need for further study in this area, and suggest that more dedicated research into cost-effectiveness of the intervention may be useful.

A Psychosocial Assessment of Patients before and after Autologous Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3152-3152
Author(s):  
Brian J. Bolwell ◽  
Linda McLellan ◽  
Larry Foster ◽  
Jane Dabney ◽  
Erin Welsh ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Autologous Transplantation ◽  
Well Being ◽  
Autologous Stem Cell Transplant ◽  
Psychosocial Assessment ◽  
Cell Transplant ◽  
Post Transplant ◽  
Allogeneic Bmt ◽  
Significant Difference

Abstract There are relatively few reports in the medical literature describing psychosocial assessment of bone marrow transplant patients; what data exists primarily focuses on allogeneic transplant recipients. We have begun to prospectively assess psychosocial parameters of patients undergoing autologous transplantation using the Functional Assessment of Cancer Therapy-BMT (FACT-BMT) tool. The general questions consist of four subscales developed and normed in cancer patients that measure; physical well-being; social/family well-being; emotional well-being; functional well-being; and a specific module to address BMT-specific concerns. Each subscale is positively scored, with higher scores indicating better functioning. A baseline survey is collected by the social worker pre-transplant and a follow-up survey is administered and collected approximately 6 weeks post-transplant by the Transplant Coordinator. 56 consecutive patients undergoing autologous stem cell transplant have FACT-BMT data both pre-transplant and approximately one month post-discharge. Median age was 50. 52% are male; underlying diagnoses include NHL (45%), Hodgkin’s disease (32%), myeloma (16%), AML (5%), testicular cancer (2%). 93% had chemosensitive disease at the time of transplant. All patients received peripheral blood progenitor cells (PBPCs), and all received a chemotherapy-only preparative regimen. All patients were hospitalized for approximately three weeks for the transplant. For most of the variables measured by the FACT-BMT tool, there was no significant difference in pre-transplant and post-transplant scores. The one variable that did change was emotional well-being: patients scored statistically significantly higher post-transplant as compared to the pre-transplant score (p&lt;0.001). We also have collected baseline FACT-BMT data on 42 consecutive allogeneic BMT recipients, as well as 12 recipients of non-myeloablative allogeneic BMT transplants. There is no significant difference in any pre-transplant variables measured by the FACT-BMT score between autologous recipients, ablative allogeneic recipients, and non-myeloablative allogeneic recipients. We conclude that patients undergoing an autologous stem cell transplant have a higher sense of emotional well-being after engraftment and hospital discharge. Presumably this reflects positive feelings about accomplishing this intensive treatment for their underlying malignancy, and suggests that emotional and physical recovery after auto-BMT is reasonably rapid. A larger dataset will hopefully allow a more detailed comparison of allo and auto BMT recipients.

Outcomes of G-CSF alone vs G-CSF with upfront plerixafor vs G-CSF/chemotherapy for collection of autologous stem cells in patients with multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19504-e19504
Author(s):  
Giampaolo Talamo ◽  
Melissa George ◽  
W. Christopher Ehmann ◽  
Joseph J. Drabick ◽  
Shin Mineishi
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Progression Free Survival ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Peripheral Blood Stem Cells ◽  
Group A ◽  
Group B

e19504 Background: Strategies for optimizing the collection of peripheral blood stem cells (PBSC) for autologous stem cell transplant (ASCT) in patients with multiple myeloma (MM) vary among transplant centers, and include the use of G-CSF alone or in combination with plerixafor, or mobilization chemotherapy + G-CSF. In 2010, we started using “upfront” plerixafor, given on the day before the PBSC collection. Methods:We retrospectively analyzed the outcomes of 423 consecutive MM patients who underwent PBSC collections at the Penn State Hershey Cancer Institute. PBSC were collected after mobilization chemotherapy + G-CSF 5 mcg/Kg/day (group A, 91 pts), G-CSF alone, 10-16 mcg/Kg/day (group B, 72 pts), and G-CSF with “upfront” plerixafor 0.16-0.24 mg/Kg on the day before the stem cell collection (group C, 245 pts). Fifteen patients were excluded from the analysis because they collected with chemotherapy + plerixafor, received pegylated G-CSF, or plerixafor “on demand”, i.e., after failure to achieve an adequate number of stem cells on the first day of collection. We compared yields, number of days required for apheresis, clinical outcomes, and adverse events among these groups. Results: The median number of PBSC collected was 16.4 (range, 0.1-134), 4.2 (range, 0-12), and 6.2 (range, 0.2-41.2) million CD34+ cells/Kg in group A, B, and C, respectively (p<0.001). The mean number of days to collect PBSC was 1.5, 1.5, and 1.3 in group A, B, and C, respectively (p=0.033). Collection failure, defined as a yield <2 million CD34+cells/Kg, was observed in 5 (5.5%), 9 (12.5%), and 15 (6.1%) patients of group A, B, and C, respectively (p<0.001). Twenty patients in group A developed neutropenic fever requiring hospital admission, and 1 of them died of septic shock, whereas no mortality was observed in groups B or C. No difference in the rapidity of PBSC engraftment, progression-free survival, and overall survival was observed among the 3 groups. Conclusions:In patients with MM, the upfront use of plerixafor with G-CSF provided the best collection strategy: it avoided the morbidity and mortality associated with the mobilization chemotherapy, and it provided higher yields than G-CSF alone.

Second Autologous Stem Cell Transplant (ASCT) as Salvage Therapy for Relapsed Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1170-1170
Author(s):  
Rebecca L. Olin ◽  
David L. Porter ◽  
Selina M. Luger ◽  
Stephen J. Schuster ◽  
Donald Tsai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Treatment Options ◽  
Univariate Analysis ◽  
Complete Response ◽  
Autologous Stem Cell Transplant ◽  
Response To Therapy ◽  
Cell Transplant ◽  
Significant Difference

Abstract Introduction: Autologous stem cell transplant (ASCT) as part of initial therapy has been shown to prolong survival of patients with multiple myeloma, with some achieving durable complete remission. However, the majority of patients ultimately relapse after ASCT and require salvage treatment. Options for the treatment of such patients have increased significantly over recent years, including not only novel chemotherapeutic and biological agents but also additional ASCTs. We performed a retrospective analysis of our experience with salvage ASCT for multiple myeloma to determine which clinical variables influence outcome. Methods: Between October 1992 and February 2005, we performed 342 ASCTs for multiple myeloma. Twenty-six of these were salvage transplants for relapsed disease after prior ASCT, and all were included in the analysis. Patients who received two planned (tandem) ASCTs were not included. Results: The median age at diagnosis was 47 (range 25–66), and median ISS and DS stages at diagnosis were 1 and 2, respectively. The initial ASCT was melphalan-based in 21/26; six (23%) achieved a complete response (CR) to the initial transplant, and fifteen (58%) achieved a partial response (PR). The median event-free survival (EFS) after the initial transplant was 19.5 months (range 2–60). The median time between initial and salvage ASCT was 2.6 years (range 0.3–7.6). Twenty-two patients (85%) received non-transplant therapy between ASCTs, and the median number of lines of therapy prior to salvage ASCT was 3. At the time of salvage ASCT, the median age was 52.5 (range 28–69). Fourteen patients received melphalan alone, eight received melphalan/TBI, and four received other regimens. Eleven patients (42%) achieved a response to therapy (1 CR, 10 PR). One patient (4%) died of transplant-related toxicity. The median follow-up after salvage ASCT is 12 months (range 0.2–58). Median EFS is 9 months, and median overall survival (OS) is 36 months. The 2-year EFS is 14%, and 2-year OS is 52%. On univariate analysis, both response to and EFS after initial transplant significantly predict improved EFS after salvage transplant (p=0.0008 and p=0.0065 respectively). Both also predict improved OS (p=0.03 and 0.0005 respectively). A greater than 12 month interval between first and second transplant also correlated with OS (p=0.04). There was no significant difference in EFS or OS by preparative regimen. Interestingly, type of response to the salvage transplant (CR/PR or less than PR) did not predict improved EFS or OS. Conclusion: This study suggests that salvage ASCT after relapse from initial ASCT is a feasible therapy for patients with heavily treated multiple myeloma, particularly those with a prolonged response to the first transplant.

The Addition of Rituximab to Standard High Dose BEAM Chemotherapy for Autologous Stem Cell Transplant in Patients with Lymphoma Does Have a Significant Effect on Engraftment.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5325-5325
Author(s):  
Francis K. Buadi ◽  
Brian McClune ◽  
Yoriann S. Hull ◽  
Furhan Yunus ◽  
Sohail Minhas ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
High Dose Chemotherapy ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Neutrophil Recovery ◽  
Cell Dose ◽  
Time Period ◽  
Neutrophil Engraftment

Abstract The addition of Rituximab to standard combination chemotherapy has significantly improved outcomes in both young and elderly patients with Non-hodgkins lymphoma (NHL). High dose chemotherapy with autologous stem cell transplant is currently the standard of care for patients with relapsed hodgkins lymphoma (HL) and NHL. However the effect of the addition of Rituximab to standard high dose chemotherapy regimen for autologous stem cell transplant on neutrophil and platelet engraftment is unknown. There are however, reported cases of neutropenia developing in patients treated with Rituximab. We performed a retrospect review of all patients with HL and NHL treated in our institution with RBEAM (Rituximab, Carmustine, Etoposide, Cytarabine, Melphalan) chemotherapy between July 2000 and June 2005 and compared it to patients receiving BEAM in the same time period. Rituximab was given at a dose of 375mg/m2 one day prior to beginning standard BEAM high dose chemotherapy. Peripheral blood was the main source of stem cells. The purpose of this study was to determine the effect of the addition of Rituximab on neutrophil and platelet engraftment. A total of 46 patients were treated during this time period. Twelve patients received RBEAM and 34 received BEAM. There was a statistical significant difference in age between the two groups. There was however no difference between the two groups in terms of race, sex and primary diagnosis. Median stem cell dose was not significantly different between the two groups. Characteristic of both groups are shown in Table: 1 Characteristics of Both Groups Median Age (yrs) Race Diagnosis Median Stem Cell Dose(x10^6) AA White HL NHL RBEAM 50.5 3 9 3 9 3.9 BEAM 36 13 21 17 17 3.8 P-VALUE 0.01 0.49 0.2 0.54 Neutrophil engraftment was defined as the first day of ANC &gt; 500 on 3 consecutive days. Platelet engraftment was defined as the first day of platelet count &gt; 20,000 with no platelet transfusion in the next seven days. The median time to neutrophil engraftment was 12 day in RBEAM compared to 11 days in BEAM (p=0.09). Platelet engraftment was however significantly delayed in patients receiving RBEAM 18days versus 12 days for BEAM (p= 0.02). Looking at both cohorts together we found that patients with HL had a significant delay in platelet engraftment compared to those with NHL (p=0.04). However there was no difference in neutrophil recovery. Although, stem cell dose affected neutrophil recovery, it had no effect on platelet engraftment. There was no increased toxicity in the early post transplant period associated with the addition of Rituximab. No bleeding complications resulted form the delay in platelet engraftment in the patients who received RBEAM. In a linear regression model the only factor that significantly affected engraftment was conditioning regimen. We conclude that the addition of Rituximab to standard high dose BEAM chemotherapy for autologous stem cell transplant has no effect on neutrophil engraftment; however platelet engraftment may be delayed. The continue use of this regimen despite the small delay in platelet engraftment will depend on whether there is any benefit, in terms of response rate, progression free and overall survival.

Outcomes and Treatments of Relapsed AL Amyloidosis Following Stem Cell Transplant

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1858-1858 ◽  
Author(s):  
Rahma Warsame ◽  
Soo-Mee Bang ◽  
Shaji K. Kumar ◽  
Martha Q Lacy ◽  
Francis K Buadi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
Autologous Stem Cell Transplant ◽  
Al Amyloidosis ◽  
Cell Transplant ◽  
Post Transplant

Abstract Abstract 1858 Systemic light chain amyloidosis (AL amyloidosis) is a condition where clonal plasma cells produce misfolded insoluble immunoglobulin light chains that deposit in various organs causing progressive organ dysfunction. Chemotherapy and autologous stem cell transplant (ASCT) when eligible is the standard treatment options for patients with AL amyloidosis. There are several studies who report long term outcomes of patient post ASCT. However, there is a paucity of literature describing the outcomes of patients who have received ASCT but have relapsed. We performed a retrospective study to assess the outcomes and treatment regimens employed following relapse after ASCT. Between 1996 and 2009, 410 patients received ASCT at the Mayo Clinic as first line therapy. Of those 410 patients 42 patients died within 3 months of transplant, 64 patients died without documented relapse, 158 patients were alive without documented progression, and 146 patients had documented progression. Those 146 patients are the subject of our study. The median time to hematologic relapse was 2 years (range: 0.2–15.5 years). At relapse, 59 patients were treated with IMiD based therapy, 36 with alkylator based therapy, 24 with bortezomib, 15 with steroids, and 5 with second ASCT. The respective hematologic response rates were 58%, 33%, 50%, 53%, and 60%. The remaining six patients were not evaluable for response for one other following reasons: organ transplants; no further therapy; inevaluable disease. With a median post relapse follow up of 3.6 years, the median overall survival (OS) from the first post ASCT relapse was 4.6 years. The median post transplant follow up was 6.1 years, the median OS for these patients was 7.3 years from the time of transplant. These data provide novel information about outcomes after SCT relapse, which should be useful not only for patients and doctors but also for investigators designing studies for salvage therapies post-transplant. Disclosures: No relevant conflicts of interest to declare.

Secondary neutropenia (SN) after autologous hematopoietic stem cell transplantation (AHSCT) in patients (pts) with lymphoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6552-6552
Author(s):  
Sunita Nathan ◽  
John Joseph Maciejewski ◽  
Elizabeth Shima Rich ◽  
Parameswaran Venugopal ◽  
Kent W. Christopherson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Stage Iv ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Cd34 Cells ◽  
Transplant Complications

6552 Background: Plerixafor for mobilization of autologous stem cells (ASC) has increased the yield of transplanted ASC and is evolving as an important option for mobilization. A prior study reported a 10% incidence of SN after AHSCT (BMT 2009 Aug; 44(3): 175-83). Incidence and outcome of SN in the setting of Plerixafor/G-CSF (P/G), is unknown. We report the incidence and possible etiology for the development of SN in pts undergoing AHSCT for lymphoma at our institution. Methods: Data from 80 consecutive AHSCT pts over a 2 year period were reviewed. All pts were mobilized using P/G. Demographics, AHSCT indication, prior therapies (Rx), conditioning regimen (CR), engraftment and post-transplant complications were identified and collected. SN was defined as ANC <1000 after initial engraftment. Results: 80 pts underwent an AHSCT for lymphoma from 2009-11. 70 pts had evaluable data. 37 (52.86%) pts (average age 55.4 yrs) were male and 33 (47.14%) pts (average age 48.3 yrs) female. 25 (35.7%) pts had ≥2 comorbidities. Indications included relapsed/ refractory B-NHL, T-NHL and HL. 47 (67%) pts had Stage IV ds, 48.9% with BM involvement. 17 (24.3%) pts had >2 Rx, 18 (25.7%) with loco-regional XRT and 3 (4.3%) with RIT. CR included BEAM, BEC and Benda-EAM +/- Rituxan. # of CD34+ cells given ranged; 1.77-19.99 x 10^6/kg. Neutrophil engraftment occurred at a median of 11 days. 26 (37.14%) pts developed SN possibly from PCP prophylactic antibiotics and infections. Prior BM involvement, Rx or XRT had no role. 5 (45.4%) pts with Benda-EAM CR had SN. Associated morbidity/mortality were not noted. Conclusions: We conclude that secondary neutropenia is common after autologous stem cell transplant using the Plerixafor/GCSF combination for mobilization and is higher than reported in the literature (37% vs 10%). Patients who received this combination for mobilization should be followed up closely in the post-transplant period for secondary neutropenia. About half the patients who received the Benda-EAM conditioning regimen developed secondary neutropenia warranting its use with caution outside of a clinical trial.

scholarly journals C- reactive protein in autologous stem cell transplantation: prediction of clinical complication

JBMTCT ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. p44
Author(s):  
Bruna Sabioni ◽  
Eduardo Edelman Saul ◽  
Rodrigo Portugal ◽  
Marcia Rejane Valentim ◽  
Angelo Maiolino ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Febrile Neutropenia ◽  
Stem Cell Transplant ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Non Hodgkin Lymphoma ◽  
Poor Outcomes

Objective: The aim of this study was to evaluate C-reactive protein (CRP) as a predictor of complications during autologous stem cell transplant (HSCT). Methods: We analyzed a cohort of 340 transplants. Correlation analyses were performed, including CRP obtained before HSCT, on Day+3, Day+6, Day+9, after Day+11, and at the onset of febrile neutropenia, and the following outcomes: bacteremia, severity of mucositis, length of neutropenia and hospitalization, and death. Results: the median age was 54 years old (ranging from 20 to 75), and 62% and 20% were multiple myeloma and non-Hodgkin lymphoma cases, respectively.  The median CRP levels increased from D+3 to D+9 and after that decreased progressively until discharge. CRP levels were associated with bacteremia, mucositis grade, length of neutropenia and hospitalization, and death. Variation in CRP values from D+3 to D+6 predicted complications. Mortality was associated with D+9 CRP levels (19 vs. 7.9 mg/dL; p<0.01), and a ROC curve area of 0.83 (95% CI 0.7 – 0.95) to predict mortality. At a cut-off of 8.5mg/dL, D+9 CRP had 83% and 79% sensitivity and specificity, respectively. Conclusions: In this study, CRP dynamics were associated with several HSCT complications. CRP levels curve could be applied to indicate poor outcomes during HSCT.

scholarly journals COMPARISON OF ANTIBIOTICS;

2018 ◽  
Vol 21 (04) ◽  
pp. 667-671
Author(s):  
Shahid Mahmood ◽  
Asma Tariq
Keyword(s):  
Febrile Neutropenia ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Significant Difference ◽  
Empiric Antibiotic ◽  
Group A ◽  
Group B ◽  
Stimulating Factor

Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibioticswithout it. Study design: Experimental study. Place and Duration of Study: Study wasconducted for a period of one year from march 2012 to february 2013 in oncology/haematologydepartment Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 childrenwith febrile neutropenia due to chemotherapy were included in the study. Two groups were madeA and B. Twenty eight patients were included in each group. Patients included in the group Awere given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five daysand the patients included in group B were not given granulocyte colony stimulating factor.Subcutaneous administration was recommended. Patients remained on study until absoluteneutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groupswas given antibiotic treatment in the hospital whenever there is need, antibiotics changedaccording to the blood culture sensitivity. Admitted patients were followed daily for fever andsigns of sepsis. Number of days of admission in hospital and number of days of treatment wascalculated in both groups and compared with each other. Duration of febrile neutropenia andmortality was also analysed for both groups. Results: Out of 56 patients 46 had acutelymphoblastic leukemia (ALL), 06 patients were of wilm tumour and 04 patient were havingrhabdomyosarcoma. Twenty eight patients were given only antibiotics(GROUP B) and 28patients were given G-CSF plus antibiotics(GROUP A). Addition of G-CSF significantly reducedneutropenia and febrile neutropenia recovery times. Median days to febrile neutropeniaresolution was 4.3 days earlier with G-CSF (5.3 vs. 9.6 days) (P < 0.0001). Resolution of fever wasone day earlier in patients who were given G-CSF (GROUP A). Hospitalization was 2.1 daysshorter with G-CSF (6.1 vs. 8.2 days) (P = 0.02). (Table II). There was difference of 2.2 days in theduration of IV and oral antibiotic treatment. Addition of antifungal therapy was done in 4 patientsin group B and only in one patient in group A. All the patients recovered and no death occurred inthe study. Conclusions: It is concluded that addition of G-CSF to empiric antibiotic therapyaccelerates chemothserapy-induced febrile neutropenia resolution by 4.3 days in pediatricpatients with malignancy. It is a significant difference in duration of hospitalization. By bearingexpenses of G-CSF we can decrease the expenses of hospitalization and antibiotics

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