Use of granulocyte colony-stimulating factor after high-dose chemotherapy and autologous peripheral blood stem cell transplantation - What is the optimal timing?

Administration of granulocyte colony-stimulating factor to patients undergo ing high-dose chemotherapy and autologous peripheral blood stem cell transp lantation accelerates neutrophil recovery and decreases hospitalization tim e. The optimal timing for granulocyte colony-stimulating factor infusion re mains unknown. In this retrospective, case-controlled, two-armed study, we reviewed our experience at Hahnemann University Hospital to determine wheth er initiating granulocyte colony-stimulating factor infusions on posttransp lant day 0 versus day 8 affects neutrophil recovery time, posttransplant di scharge date, total hospital days after high-dose chemotherapy, and autolog ous peripheral blood stem cell transplantation. All patients hospitalized b etween 1994 and 1998 at Hahnemann University Hospital. Bone Marrow Transpla ntation Unit with breast cancer or non-Hodgkin's lymphoma, who underwent hi gh-dose chemotherapy followed by autologous peripheral blood stem cell tran splantation and received granulocyte colony-stimulating factor either on po sttransplant day 0 (16 patients) or day 8 (16 patients). The day 0 and day 8 groups had no statistically significant differences in age, sex, weight, height, body surface area, disease characteristics, pretransplant harvestin g or conditioning regimens, or transplant CD34(+) cell counts. Our main out come measure was the mean time to reach absolute neutrophil count greater t han or equal to 0.5 X 10(9)/1, the number of hospital days after transplant , and the total hospital days. The mean days to neutrophil recovery (10.56 versus 9.68, p = 0.48), posttransplant hospital days (13.62 versus 12.81, p = 0.39), acid total hospital days (20.25 versus 20.25. p = 1.00) were not significantly different between day 8 and day 0 groups, respectively. No si gnificant effects on neutrophil recovery time, posttransplant hospital days , or total hospital days were observed with the initial granulocyte colony- stimulating factor infusion on day 0 versus day 8 after transplant. Delayed administration may allow substantial cost savings (US$200 X 8 congruent to US$1,600 per patient) without affecting clinical outcome. More studies are needed to determine whether greater delay is feasible.