Cost effectiveness of G-CSF after allogeneic peripheral blood stem cell transplant.

e18540 Background: In spite of the fact G-CSF has been used post stem cell transplant (SCT) to accelerate neutrophil engraftment its use post allogeneic SCT remains controversial. ASCO does not recommend its use after allogeneic SCT. To further evaluate the effectiveness of its use, we compared outcomes in pts who underwent related and unrelated peripheral blood SCT(PBSCT) either with or without the use of G-CSF post SCT. Methods: This is a retrospective study comparing early outcomes in pts who received G-CSF starting on day + 6 post SCT until engraftment with pts who did not receive a planned course of G-CSF. Pts who underwent Allogeneic PBSCT between 2012-2014 at our institution were included. Pts who received marrow, haploidentical or cord blood transplants were excluded. Associations with survival outcomes were assessed by univariable and multivariable Cox proportional regression models. Results: A total of 162 patients were evaluated. Sixty-five pts received G-CSF post SCT and 97 did not. The only difference between the two groups was that more pts in the G-CSF group received myeloablative-conditioning (MAC) regimen (78% vs. 55%, p = 0.008). Other pt characteristics were not significantly different. Length of hospital stay was significantly lower in the G-CSF group (24 vs. 27 days P = 0.002). Pts who received G-CSF had earlier neutrophil engraftment (median, days 11 vs. 14 p = < 0.001). The median day of platelet engraftment was 15 days in both groups. There was no significant difference between the 2 groups in re-admissions in the first 100 days, and the incidence of acute or chronic GVHD. In multivariate analysis use of G-CSF did not significantly impact non- relapse mortality, relapse free survival and overall survival. However, relapse rate was significantly lower in G-CSF group in multivariable analysis (hazards ratio = 0.44, p = 0.03). Conclusions: Use of G-CSF post allogeneic PBSCT is associated with earlier neutrophil engraftment, shorter hospital stay and a suggestion of a reduced relapse rate after PBSCT. Our experience suggests that use of G-CSF (on average for approximately 5 days) in this setting is cost effective as it reduces hospitalization duration without adversely impacting post-transplant outcomes.

Download Full-text

G-CSF use post peripheral blood stem cell transplant is associated with faster neutrophil engraftment, shorter hospital stay and increased incidence of chronic GVHD

Leukemia & Lymphoma ◽

10.1080/10428194.2020.1827244 ◽

2020 ◽

pp. 1-8

Author(s):

Vijendra Singh ◽

Hyejeong Jang ◽

Seongho Kim ◽

Lois Ayash ◽

Asif Alavi ◽

...

Keyword(s):

Stem Cell ◽

Hospital Stay ◽

Peripheral Blood ◽

Stem Cell Transplant ◽

Peripheral Blood Stem Cell ◽

Chronic Gvhd ◽

Blood Stem Cell ◽

Cell Transplant ◽

Neutrophil Engraftment

Download Full-text

Conditioning with Fludarabine, Busulfan, and ATG Prior to Reduced-Intensity Allogeneic Stem Cell Transplant for CLL Is Associated with a Low Incidence of Acute Graft-Versus-Host Disease.

Blood ◽

10.1182/blood.v116.21.4568.4568 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4568-4568

Author(s):

Samantha M. Jaglowski ◽

Diane Scholl ◽

Patrick Elder ◽

Thomas S. Lin ◽

John C. Byrd ◽

...

Keyword(s):

Stem Cell ◽

Graft Versus Host Disease ◽

Stem Cell Transplant ◽

Chronic Gvhd ◽

Cell Transplant ◽

Allogeneic Stem Cell Transplant ◽

Graft Versus Host ◽

Significant Difference ◽

Reduced Intensity ◽

Count Recovery

Abstract Abstract 4568 Introduction: Allogeneic stem cell transplant (SCT) is the only potentially curative treatment available for CLL. While transplant-related mortality has decreased with use of reduced-intensity conditioning (RIC) regimens, acute and chronic graft-versus-host-disease (GVHD) remain important causes of morbidity and mortality, with up to 50% of patients developing chronic GVHD (cGVHD). While the optimal way to combat this has not been established, in vitro T cell depletion with ATG or alemtuzumab has been employed to attempt to lessen its incidence. Herein, we report our institutional experience with each of these agents. Patients and methods: Information on all patients who underwent RIC allogeneic SCT at Ohio State from January 1, 2002 to June 29, 2010 was obtained following approval from the ORRP. Data collected by the transplant coordinators was correlated with data in our electronic databases. Comparative statistics were performed using the Fisher exact test and all p-values are two-sided. Results: Between January 1, 2002 and June 29, 2010, 50 patients with CLL/SLL underwent RIC allogeneic SCT at Ohio State. Pretransplant characteristics are listed in Table 1. Thirty patients received fludarabine, busulfan, and ATG (FBA) as a preparative regimen, and 8 patients received alemtuzumab, fludarabine, and TBI (Cam/Flu/TBI). Another 6 patients received fludarabine and busulfan, 4 received fludarabine and cyclophosphamide, one received pentostatin, fludarabine, and ATG, and the patient who had a cord blood transplant received fludarabine, cyclophosphamide, TBI, and ATG. The breakdown of characteristics between patients who received FBA and Cam/Flu/TBI is also provided in Table 1. None of the characteristics were statistically different. Time to count recovery is provided in Table 2. There was not a statistically significant difference in the time to count recovery between FBA and Cam/Flu/TBI. Patients who received Cam/Flu/TBI received significantly more DLIs; patients who received FBA have not required any DLIs. Incidence of acute and chronic GVHD is provided in Table 3. There was not a statistically significant difference in rates or grades of aGVHD, but patients who received Cam/Flu/TBI were more likely to develop extensive cGVHD. Conclusions: While patients who received Cam/Flu/TBI were more likely to receive DLI, these were all done to treat disease recurrence, reflecting changes in group practice over time. There were no failures to engraft with FBA, and while not statistically significant in comparison to Cam/Flu/TBI, only 10% of patients developed grade 3 or 4 aGVHD. All of the patients who received Cam/Flu/TBI and developed cGVHD developed extensive disease. While the Cam/Flu/TBI sample is small, the FBA patients appear to fare no worse in terms of count recovery and development of GVHD without exposure to TBI, and this has become our institutional practice for patients with CLL. Disclosures: Lin: GlaxoSmithKline: Consultancy, Employment.

Download Full-text

Pegfilgrastim to accelerate neutrophil engraftment following peripheral blood stem cell transplant and reduce the duration of neutropenia, hospitalization, and use of intravenous antibiotics: a phase II study in multiple myeloma and lymphoma and comparison with filgrastim-treated matched controls

Leukemia & Lymphoma ◽

10.3109/10428194.2010.545462 ◽

2011 ◽

Vol 52 (3) ◽

pp. 436-443 ◽

Cited By ~ 9

Author(s):

Luciano Wannesson ◽

François Luthi ◽

Emanuele Zucca ◽

Anne Rosselet-christ ◽

Mauro Baglioni ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Phase Ii ◽

Peripheral Blood ◽

Stem Cell Transplant ◽

Peripheral Blood Stem Cell ◽

Phase Ii Study ◽

Cell Transplant ◽

Intravenous Antibiotics ◽

Neutrophil Engraftment

Download Full-text

Haematopoietic Stem Cell Transplantation: A Single Centre Experience from Army Hospital (Research & Referral), New Delhi, India

Blood ◽

10.1182/blood.v112.11.4377.4377 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4377-4377

Author(s):

Velu Nair ◽

Ajay Sharma ◽

Satyaranjan Das ◽

Deepak Kumar Mishra ◽

Jyoti Kotwal ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Peripheral Blood ◽

Myeloid Leukemia ◽

Stem Cell Transplant ◽

Chronic Gvhd ◽

Haematopoietic Stem Cell ◽

Cell Transplant ◽

Overall Mortality

Abstract Haematopoietic stem cell transplantation {HSCT} is being offered as a definitive mode of therapy in various hematological disorders. We present retrospective data of 113(39 females) patients who underwent HSCT in High Efficiency Particulate Air {HEPA} filtered unit. Of these, 36 underwent Autologous HSCT {Auto-HSCT} comprising of 15 patients for Acute Myeloid Leukemia {AML} and 21 for Multiple Myeloma{MM}.). The indications for Allogenic HSCT {Allo-HSCT} were Chronic Myeloid Leukemia{CML}-19;AML-17; Thalassaemia Major-18;Myelodysplastic Syndrome{MDS}-01; Acute Lymphoblastic Leukemia-09,; Severe Aplastic Anemia {SAA}-09; Pure red cell Aplasia-02 and Juvenile Myelomonocytic Leukemia-02. All allogeneic recipients, received stem cells from HLA matched siblings. The conditioning was done with standard busulfan-cyclophosphamide (Bu-Cy) based protocols for leukemia; fludarabine, cyclophosphamide & Anti-Thymocyte globulin {ATG} for SAA; Bu-Cy-ATG for thalassemia and melphalan for MM. The mean age was 25 years (2–60). The median cell dose was 6.0×108MNC/Kg (2.2–11.7). The median day of engraftment for neutrophils (ANC > 500/mm3) was on day 11(7–22) and for platelets (Plt >20,000/mm3) it was on day 13(8–37). Peripheral blood was used as a source of stem cells for all patients who underwent Auto-HSCT, except for two patients where bone marrow was also harvested in addition, to achieve adequate cell dose. For Allo-HSCT, peripheral blood was used for 47 patients and bone marrow for 29 patients. Both bone marrow and cord blood was used in one patient for Allo-HSCT. Analysis of All-HSCT: Analysis revealed 13/77(16.88%) patients developed sinusoidal obstruction syndrome {SOS}. Of these 06 had severe SOS and 04 of them died. 5/77(6.49%) patients developed hemorrhagic cystitis who responded to conservative management. Incidence of grade III/IV acute graft versus host disease {GVHD} was 10/77 (12.98%), of which 4 patients died. Of these, 3 were Thalassemia Major patients who underwent bone marrow stem cell transplant {BMSCT} while the remaining were hematological malignancies (CML-04; AML-01; ALL-02) who underwent peripheral blood stem cell transplant {PBSCT}. Also, 20/77 (25.97%) patients were noted to have chronic GVHD (Limited-12 & Extensive-08). Interestingly there was strikingly higher incidence of chronic GVHD in the PBSCT group i.e. 19/47 (40.43%) as compared to BMSCT group where it was only 1/30 (3.34%). This was found to be statistically significant (p<0.05). The overall mortality in Allo-HSCT group was 27/77 (35.07%) which included 10 deaths due to relapse of the underlying disease. Transplant related mortality (TRM) was 17/77(22.08%). In the TRM group, 11 were PBSCT while 6 were BMSCT. TRM <100 days comprised of 13/77 (16.88%) patients and causes of death were sepsis (06); severe VOD (04) and acute GVHD (03). Overall survival was 50/77 (64.94%) with a median follow up of 450 days (90–2329). Analysis for Auto-HSCT: Only two i.e. 2/36 (5.56%) patients developed mild SOS. Overall mortality in this subset was 6/36 (16.67%). This included only one TRM i.e. 1/36 (2.78%) and 05 deaths due to relapse of the disease (AML-3 & MM-2). Two patients have died due to unrelated causes (one due to heat stroke and one due to head injury). Two patients have been lost to follow up. Overall survival was 26/34(76.47%) with a median follow up of 579 days (90–2414).

Download Full-text