COMPARISON OF G-CSF WITH GM-CSF FOR MOBILIZING PERIPHERAL-BLOOD PROGENITOR CELLS AND FOR ENHANCING MARROW RECOVERY AFTER AUTOLOGOUS BONE-MARROW TRANSPLANT

Primed peripheral blood progenitor cells (PBPC) with hematopoietic gro wth factors enhance marrow engraftment after autologous bone marrow tr ansplantation (BMT). G-CSF and GM-CSF stimulate the production of PBPC ; both cytokines alone also stimulate neutrophil recovery after autolo gous BMT. Little data exist comparing these two cytokines. We prospect ively studied G-CSF and GM-CSF in autologous BMT. Forty-four consecuti ve patients with either Hodgkin's disease or non-Hodgkin's lymphoma un derwent autologous BMT using both PBPC and autologous marrow. The auto logous BMT preparative regimen was CBV (VP-16 2400 mg/m(2), CY 1800 mg /m(2) iv four times daily for 4 days, BCNU 600 mg/m(2)). Sixteen patie nts received G-CSF 5 mu g/kg sc daily for 8 days for mobilization of P BPC and received G-CSF 16 mu g/kg iv four times daily after autologous BMT. Twenty-eight patients received GM-CSF to mobilize PBPC (14 patie nts received 250 mu g/m(2) sc daily for 8 days; 14 patients received 1 25 mu g/m(2) sc twice daily for 8 days) and GM-CSF (250 mu g/m(2) iv f our times daily) after autologous BMT. Patients underwent three to fiv e pheresis procedures to harvest at least 3 X 10(8) nucleated cells/kg . Patients receiving G-CSF had higher peripheral WBC counts than did t hose receiving GM-CSF. Total numbers of mononuclear cells, total CD34( +) cells and total CD34(+)/33-negative cells were similar in the two t reatment groups. The patients receiving G-CSF after autologous BMT exp erienced a more rapid engraftment of both neutrophils (9 days vs 13 da ys, p = 0.0001) and platelets (14 days vs 18 days, p = 0.027) than did patients receiving GM-CSF after transplant. The divided doses of GM-C SF had no effect on any variable measured. Both cytokines, with PBPC, lead to rapid marrow engraftment. Since total number of mononuclear ce lls, total CD34(+) cells and total CD34(+)/33(-) cells were similar in both groups, the enhanced rate of engraftment of neutrophils and plat elets in the G-CSF group may be the result of the use of G-CSF post-tr ansplant.