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Although Recommended, G-CSF After Marrow Transplant May Raise Graft-Versus-Host Disease Risk

March 3, 2004 (Reuters)

NEW YORK - Treatment with granulocyte colony-stimulating factor (G-CSF) after allogeneic bone marrow transplantation for acute leukemia may increase the risk of graft-versus-host disease (GVHD) and death, according to a new report. Current recommendations include the use of G-CSF to speed neutrophil recovery after hematopoietic stem-cell transplantation, the authors note.

As reported in the Feb. 1 Journal of Clinical Oncology, Dr. Olle Ringden from the Karolinska Institute, Stockholm, Sweden, and colleagues evaluated the clinical effects of G-CSF after bone marrow transplant and peripheral-blood stem-cell transplantation from HLA-identical siblings in more than 2,200 patients with acute myeloid leukemia and acute lymphoblastic leukemia.

G-CSF treatment was associated with a significantly faster neutrophil recovery and a significantly delayed platelet recovery, the authors report.

Among bone marrow transplant patients (but not among peripheral stem-cell transplant patients), G-CSF treatment was associated with an increased risk of acute GVHD (50 percent versus 39 percent) and chronic GVHD (37 percent versus 28 percent) compared with controls who did not receive G-CSF, the report indicates.

Bone marrow transplant recipients who received G-CSF had higher two-year transplant-related mortality (27 percent versus 17 percent) and a lower two-year probability of overall survival (48 percent versus 58 percent), compared with controls who did not receive G-CSF, the researchers note.

Transplant-related mortality, relapse, survival, and leukemia-free survival did not differ according to G-CSF treatment in patients who received peripheral-blood stem-cell transplants, the results indicate.

"Despite the limitations of the study," the authors conclude, "there is little reason to treat allogeneic bone marrow transplant patients with G-CSF as prophylaxis after transplantation. Although engraftment of absolute neutrophil count is faster, this is offset by a delay in the engraftment of platelets. Moreover, the risk of GVHD, along with an increase in transplant-related mortality and reduction in the survival and leukemia-free survival rates, call into question the use of G-CSF as prophylaxis in bone marrow transplant patients."

In a related editorial Dr. Frederick R. Appelbaum from Fred Hutchinson Cancer Research Center, Seattle, Washington writes, "While the effects of G-CSF after marrow transplantation may not be as deleterious as suggested in (this paper), the beneficial effects also seem relatively restricted. Thus, despite the limitations of the current article, the authors' conclusion...seems reasonable."

J Clin Oncol 2004;22:416-423,390-391.

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