Use of concurrent G-CSF plus GM-CSF vs G-CSF alone for mobilization of peripheral blood stem cells in children with malignant disease

There is limited experience in the mobilization of peripheral blood progeni tor cells (PBPC) in children and the optimal method for PBPC mobilization i s unknown. The present study was conducted to ascertain whether mobilizatio n with G-CSF + GM-CSF (group I) provides some advantage over G-CSF alone (g roup II) in terms of collected CD34(+) cells and hematopoietic recovery fol lowing myeloablative conditioning in children with malignancies. An economi c analysis was also performed. Each group comprised 21 consecutive patients . The mean number of aphereses was 1.5 +/- 0.5 in group I and 1.2 +/- 0.46 in group II (NS), The mean number of CD34(+) cells was 3.8 x 10(6) +/- 4.03 /kg in group I and 4.2 +/- 5.4 in group II (IVS). The mean number of total blood volumes (TBV) processed was 4.4 +/- 1.5 in group I and 4.3 +/- 1.5 in group II (NS). The mean duration of the procedure was 276 +/- 74.1 min in group I and 286.7 +/- 75.9 min in group II (NS), and the inlet flow was 45. 1 +/- 12 ml/min in group I and 39.5 +/- 15.1 ml/min in group II (NS), No si gnificant differences in the neutrophil and platelet engraftment probabilit y were observed between the two groups. The mean overall cost of group II w as not statistically significant from that of group I (US$ 9521 +/- 330 vs US$ 10201 +/- 1028, P = NS). The cost of mobilization was significantly hig her in group I than in group Ill conditioning regimen costs were similar in both groups and the costs related to the post-transplant period were simil ar in both groups. We conclude that PBPC mobilization with G-CSF + GM-CSF i n children does not enhance hematological recovery in comparison with mobil ization using S-CSF alone. However, the combination of G-CSF + GM-CSF does not significantly increase the overall cost of transplantation.