GRANULOCYTE-COLONY-STIMULATING FACTOR FOLLOWING PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANT IN NON-HODGKINS-LYMPHOMA

Purpose: To compare the hematologic recovery after high-dose chemother apy and circulating peripheral-blood progenitor-cell (PBPC) transplant between patients who received recombinant human granulocyte colony-st imulating factor (G-CSF) (treated group) and those who did not (contro l group). Patients and Methods: From December 1992 through June 1994, two sequential and consecutive cohorts of 20 patients each with histol ogically proven non-Hodgkin's lymphoma (NHL) received high-dose chemot herapy (carmustine [BCNU], cytarabine [Ara-C], etoposide, and melphala n [BEAM]) followed by PBPC transplant. The first 20 patients were trea ted with G-CSF (5 mu g/kg/d) after PBPC administration. Since the time of platelet and leukocyte recovery in this group was short (< 15 days ), with a narrow standard deviation from the mean value, the last 20 p atients were not given G-CSF. Hematologic recovery, number of febrile days, rate of documented infections, number of hospital days, duration of gastrointestinal complications, platelet and RBC transfusions, and antibiotic requirements were compared in the two groups. Results: The two groups of patients were comparable according to disease status, h istology, stage, bulky disease bone marrow involvement, elevated lacta te dehydrogenase (LDH) level, and median number of infused CD34(+) cel ls and colony-forming units granulocyte-macrophage (CFU-GM). The media n time to reach 0.5 x 10(9)/L and 1.0 x 10(9)/L neutrophils was 2 days shorter in G-CSF group, but this difference was not statistically sig nificant. The median times to reach 20 x 10(9)/L and 50 x 10(9)/L plat elets were, respectively, 10 and 14 days in the G-CSF group and 11 and 16 days in the control group, but again this was not statistically si gnificant. Moreover, when considering clinically relevant end points i ncluding the number of documented infections and antibiotic requiremen ts, platelet transfusions, gastrointestinal toxicity, and days of hosp italization, no differences were demonstrated between the two groups. Conclusions: Provided an optimal dose of circulating progenitors is in fused, NHL patients transplanted with PBPC do not benefit by the admin istration of hematopoietic growth factors.