FILGRASTIM FAILS TO IMPROVE HEMATOPOIETIC RECONSTITUTION FOLLOWING MYELOABLATIVE CHEMOTHERAPY AND PERIPHERAL-BLOOD STEM-CELL RESCUE

The morbidity of high-dose chemotherapy has been considerably reduced by the use of autologous peripheral blood progenitor cell reinfusion. Most studies have used myeloid colony-stimulating factors after stem c ell reinfusion, making it difficult to determine the relative contribu tion of each of these variables to the early recovery of blood cells. The financial implications of colony-stimulating factor use are an are a of concern as dose intensification in chemosensitive malignancies is increasingly employed. We have studied 19 consecutive patients receiv ing high-dose chemotherapy with and without filgrastim (Amgen, granulo cyte colony-stimulating factor, G-CSF) after stem cell infusion to exa mine its effect on the kinetics of blood cell recovery, the complicati ons of myelosuppression and the associated costs. Analysis of the two treatment groups reveals that administration of filgrastim 10 mu g kg( -1) day(-1) following stem cell reinfusion does not further accelerate haemopoietic recovery, fails to reduce the incidence of neutropenic f ever or antibiotic usage and significantly increases the cost of the p rocedure. The results of this study do not support the routine use of filgrastim after high-dose chemotherapy and peripheral blood stem cell reinfusion.