Long-term follow-up after allogeneic granulocyte colony-stimulating factor-primed bone marrow transplantation

Granulocyte colony-stimulating factor (G-CSF) priming increases the number of progenitor cells in harvested bone marrow (BM) and has been used for all ogeneic transplantation. Primed bone marrow (pBM) seems to offer faster eng raftment than steady-state BM, but the stability of such engraftment has be en questioned. The incidence of graft-versus-host disease (GVHD) and diseas e relapse after pBM, compared with such incidence after BA I or peripheral blood progenitor allotransplantation, has not been established. We studied the long-term outcome (median follow-up, 24 months) of sibling matched allo grafting with G-CSF pBM. Seventeen patients received pBM from matched sibli ng donors primed with G-CSF 10 mug/kg per day for 2 days before BM harvest. Conditioning consisted of total body irradiation and cyclophosphamide (CY) ; busulfan and CY; or total lymphoid irradiation, CI: and antithymocyte glo bulin. All infused grafts contained greater than or equal to3.5 to 4 x 10(8 ) mononuclear cells per kilogram. Ten of 17 patients received methotrexate as part of their GVHD prophylaxis. International Bone Marrow Transplant Reg istry definitions for engraftment were used. Control subjects consisted of 112 consecutive patients who received allogeneic transplantation at our ins titution with steady-state BM; control subjects for length of hospitalizati on consisted of the subset of patients who underwent transplantation during 1996. Neutrophil engraftment occurred a median of 7 days earlier in primed bone marrow transplantation (DBMT) patients when compared with steady-stat e BMT patients; this shortened hospitalization by a median of 11 days. The peritransplant mortality rate was 18% in pBMT patients and 25% in BMT patie nts (not significant). The rate of GVHD of grade >II and the rate of relaps e were almost identical in pBMT and BMT patients (GVHD: 18% and 19%, respec tively; relapse: 14% and 13%, respectively). There were 4 transplant-relate d deaths within the first 100 days; 1 patient died of disease relapse on da y 470. Twelve patients remained alive on days 430 through 1522 after BMT. R esults showed that pBM allografts resulted in more rapid engraftment and sh orter hospitalization. All patients maintained stable donor engraftment. In this cohort of patients, G-CSF pBMT resulted in rates of GVHD, disease rel apse, and peritransplant mortality that were similar to those produced by c onventional BMT.