Individually determined dosing of filgrastim after autologous peripheral stem cell transplantation in patients with malignant lymphoma -results of a prospective multicentre controlled trial
Abstrakt
To explore the safety and effectiveness of the individually determined application granulocyte-colony stimulating factor (G-CSF) after autologous peripheral blood stem cell transplantation (ASCT). Methods: The administration of G-CSF from day +5 (arm A) was compared in a randomised, controlled trial with delayed, individually determined administration (G-CSF started when WBC }= 0.5 x 10(9)/L and ANC }= 0.1 x 10(9)/L or at day +10; arm B), and with placebo (arm C).
Results: One hundred and six patients, median age 45 (range 21-64), all with malignant lymphoma treated with BEAM chemotherapy were analysed. A significant difference in the time to neutrophil engraftment and in the duration of neutropenia 0.5 x 10(9)/L after graft re-infusion was 10 (9-14) in arm A; 11 (9-19) in arm B; and 14 (10-30) in arm C (P 20 x 10(9)/L and > 50 x 10(9)/L was significantly delayed in the arms using G-CSF in comparison with placebo (P = 0.04-0.002) without any increase in bleeding or in transfusion requirement.
There was no difference in the incidence and duration of transplant-related complications and their treatment between the arms. Conclusions: Our study has confirmed the safety of individually determined administration of G-CSF.
The optimal timing of G-CSF application after ASCT in patients with good-quality grafts is shortly before expected spontaneous engraftment