INDIVIDUAL CRITERIA COULD BE OPTIMAL FOR STARTING G-CSF APPLICATION AFTER AUTOLOGOUS STEM-CELL TRANSPLANTATION

The optimal time for starting G-CSF application after autologous perip heral stem cell transplantation (APSCT) still remains undetermined, Al l previous studies used 'fixed' days (0 or +1 vs +5 or +7 post-transpl ant) for this purpose, As many other drugs have individual, patient-de pendent criteria leg antibiotics, blood products, etc), and the discon tinuation of G-CSF also has strict patient-dependent criteria (surpris ingly absent when starting the drug) we suppose that attempts to find general criteria suitable for every patient may not be successful, In order to also take the patients' individual predispositions into accou nt we designed a randomized clinical trial to compare 'immediate' admi nistration of G-CSF (day +1: group A) vs 'delayed, patient-dependent' (first day when absolute neutrophil count (ANC) was below 0.5 x 10(9)/ l: group B) therapy with G-CSF (both groups received 10 mu g/kg/day i. v.). A total of 70 patients after APSCT suffering from non-Hodgkin's l ymphoma (NHL) and Hodgkin's disease (HD) conditioned with BEAM, or fro m multiple myeloma (MM) after melphalan (L-PAM: 200 mg/m(2)) were enro lled in this study (35 in each group), Both groups were comparable wit h regard to age, sex, disease stage and previous therapy as well as th e number of CD34(+) cells transplanted, In group B, G-CSF administrati on began on day +4 post-transplant (+2-+5), There were no detectable d ifferences seen in the hematopoietic recovery (time to reach ANC more than 0.5 x 10(9)/l: 12 days vs 13 days; time to platelet recovery, mor e than 50 x 10(9)/l: 24 days in both groups), use of blood products or antibiotics, infections, or days of hospitalization, Delayed G-CSF ap plication led to significant cost saving in terms of APSCT (approximat ely US$1341 for each patient), We suggest that 'patient-dependent' cri teria for starting G-CSF are reasonable especially in patients conditi oned with protocols only slowly inducing neutropenia: eg NHL and HD pa tients after BEAM, MM after L-PAM or patients after busulphan and cycl ophosphamide (BUCY2).