Controlled trial of filgrastim for acceleration of neutrophil recovery after allogeneic blood stem cell transplantation from human leukocyte antigen-matched related donors

The rapid recovery of hematopoiesis after allogeneic blood stem cell transp lantation has been attributed to the quality and quantity of hematopoietic progenitors in the blood stem cell grafts from filgrastim-stimulated donors . To determine whether further stimulation with filgrastim after transplant ation would affect hematopoietic recovery, a prospective, randomized, contr olled study was performed. Forty-two adult recipients of allogeneic blood s tem cells from human leukocyte antigen-matched related donors were randomiz ed to receive 10 mug/kg per day filgrastim subcutaneously from day 10 throu gh neutrophil recovery or no growth factor support after transplantation. T here was no significant difference between the 2 groups in the number of CD 34(+) cells infused (median, 4.8 vs 4.3 x 10(6)/kg). Graft-versus-host (GVH D) disease prophylaxis consisted of tacrolimus and steroids for 9 patients and tacrolimus and minimethotrexate for 33 patients. The group receiving fi lgrastim had a shorter time to neutrophil levels greater than 0.5 x 10(9)/L (day 12 vs day 15, P=.002) and to neutrophil levels greater than 1.0 x 10( 9)/L (day 12 vs day 16, P=.01), The filgrastim group also had a trend for e arlier discharge (day 16 vs 20, P = .05), There was no significant differen ce between the groups in time to platelet recovery, number of transfusions, regimen-related toxicity, infection, incidence of GVHD, relapse, survival, or hospital charges. It can be concluded that the administration of filgra stim after allogeneic blood stem cell transplantation shortens the time to neutrophil recovery. (Blood. 2001;97:3405-3410) (C) 2001 by The American So ciety of Hematology.