Hematopoietic growth factor after autologous peripheral blood transplantation: comparison of G-CSF and GM-CSF

Autologous peripheral blood stem cell (PBSC) transplantation results in rap id hematologic recovery when sufficient numbers of CD34(+) cells/kg are inf used. Recent studies suggest that filgrastim (G-CSF) administration followi ng transplantation leads to more rapid neutrophil recovery and lower total transplant costs. This study compares the use of G-CSF (5 mu g/kg/day) with sargramostim (GM-CSF) 500 mu g/day from day 0 until neutrophil recovery (A NC >1500/mm(3)) in patients with breast cancer or myeloma who had PBSC mobi lized with the combination of cyclophosphamide, etoposide, and G-CSF, Twent y patients (13 breast cancer and seven myeloma) received GM-CSF and 26 pati ents (14 breast cancer and 12 myeloma) received G-CSF. The patients were co mparable for age and stage of disease, and received stem cell grafts that w ere not significantly different (CD34(+) x 10(6)/kg was 12.5 +/- 11.1 (mean +/- s.d.) for GM-CSF and 19.8 +/- 18.5 for G-CSF; P = 0.10). The use of re d cells (2.8 vs 2.3 units), and platelet transfusions (2.5 vs 3.1) was simi lar for the two groups, as was the use of intravenous antibiotics (4.3 vs 4 .6 days) and the number of days with temperature >38.3 degrees C (2.3 vs 1. 8). Platelet recovery was also similar in both groups (platelets >50 000/mm (3) reached after 11.8 vs 14.9 days). The recovery of neutrophils, however, was faster using G-CSF, ANC >500/mm(3) and >1000/mm(3) were reached in the GM-CSF group at 10.5 +/- 1.5 and 11.0 +/- 1.7 days, respectively, whereas with G-CSF only 8.8 +/- 1.2 and 8.9 +/- 2.2 days were required (P < 0.001). As a result, patients given G-CSF received fewer injections than the GM-CS F patients (10.9 vs 12.3). Resource utilization immediately attributable to the use of growth factors and the duration of pancytopenia, excluding hosp italization, were similar for the two groups. This study suggests that neut rophil recovery occurs more quickly following autologous PBSC transplant us ing G-CSF in comparison to GM-CSF, but the difference is not extensive enou gh to result in lower total cost.