PLASMA-LEVELS OF GRANULOCYTE-COLONY-STIMULATING FACTOR IN PATIENTS AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA CORRELATE WITH ENGRAFTMENT OF TRANSPLANTED MARROW

Granulocyte colony-stimulating factor (G-CSF) is considered to play a pivotal role in hemopoietic regulation, Its pharmacological applicatio n is reported to shorten chemotherapy-induced neutropenia as well as t ime to engraftment in patients after bone marrow transplantation (BRIT ), In order possibly to establish further rationale for G-CSF treatmen t strategies in patients undergoing BMT, me evaluated G-CSF plasma lev els of 89 patients after allogeneic BMT for chronic myeloid leukemia ( Chit), EDTA anti-coagulated plasma samples were collected starting on day -1 (before grafting) and thereafter twice weekly for four consecut ive weeks, G-CSF levels were estimated by enzyme immunoassay. Patients with late (>30 days) bone marrow engraftment had consistently higher G-CSF levels at day +1 (after grafting) compared to patients with earl y (less than or equal to 30 days) engraftment, while all patients had low plasma levels on day -1/0. Mean G-CSF plasma levels and time to en graftment were correlated (r = 0.79), In univariate analyses, high G-C SF levels at days +1, +4, +7, +10 and several clinical variables (such as TBI, unrelated donor transplant, state of disease) were predictive of late engraftment, Further analysis by multivariate Cos regression resulted in the following predictive model: high G-CSF plasma levels a t day +7 and +10 (after grafting), in combination with a blastic phase of the disease were highly predictive of late engraftment, The signif icantly higher G-CSF levels in patients with impaired engraftment may reflect early compensating mechanisms of the hemopoietic system, which should be investigated further.