Efficacy of deferred dosing of granulocyte colony-stimulating factor in autologous hematopoietic transplantation for multiple myeloma

J. E. Cox, Samuel K Campos, J. Wu, R. May, H. Liu, C. A. Ramos, G. Carrum, H. E. Heslop, M. K. Brenner, R. T. Kamble

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Routine administration of G-CSF following autologous hematopoietic SCT (ASCT) expedites ANC recovery and reduces hospitalization by 1-2 days; it has no impact on febrile neutropenia, infections, morbidity, mortality, event-free survival or OS. To determine whether delayed G-CSF dosage could result in equivalent ANC recovery and thereby improve cost effectiveness, we deferred the administration of G-CSF until WBC recovery had begun. A total of 117 patients with multiple myeloma received ASCT from January 2005 to September 2012. Of these, 52 were in the conventional dosing group (CGD) and received G-CSF from Day +7 for a median of five doses. In the deferred dosing group (DGD), 65 patients received G-CSF from median day 14 post transplant for a median of zero doses. There was no difference between groups in the incidence or duration of febrile neutropenia, duration of ≥grade III mucositis, weight gain, rash, engraftment syndrome or early death (100 days). The DGD group had a significantly longer time to neutrophil engraftment than the CGD group (15 days vs 12 days; P<0.0001), a longer period of severe neutropenia (<100/μL; 8 days vs 6 days; P<0.0001), longer treatment with intravenous antibiotics (7 days vs 5 days; P=0.016) and longer hospital stay (19 days vs 17 days; P=<0.0001). Although the cost of G-CSF was lower in the DGD group (mean 308 vs 2467), the additional hospitalization raised the median total cost of ASCT in this group by 17%. There was, however, no adverse effect of deferred dosing on the rate of febrile neuropenic episodes or Day 100 survival, so that deferred dosing of G-CSF may be suitable for patients receiving ASCT as outpatients, for whom longer hospital stay would not be an offsetting cost.

Original languageEnglish (US)
Pages (from-to)219-222
Number of pages4
JournalBone Marrow Transplantation
Volume49
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Autologous Transplantation
Granulocyte Colony-Stimulating Factor
Multiple Myeloma
Febrile Neutropenia
Costs and Cost Analysis
Length of Stay
Hospitalization
Mucositis
Exanthema
Neutropenia
Disease-Free Survival
Weight Gain
Cost-Benefit Analysis
Neutrophils
Fever
Outpatients
Anti-Bacterial Agents
Morbidity
Transplants
Survival

Keywords

  • Autologous transplant
  • G-CSF
  • Multiple myeloma

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Efficacy of deferred dosing of granulocyte colony-stimulating factor in autologous hematopoietic transplantation for multiple myeloma. / Cox, J. E.; Campos, Samuel K; Wu, J.; May, R.; Liu, H.; Ramos, C. A.; Carrum, G.; Heslop, H. E.; Brenner, M. K.; Kamble, R. T.

In: Bone Marrow Transplantation, Vol. 49, No. 2, 02.2014, p. 219-222.

Research output: Contribution to journalArticle

Cox, J. E. ; Campos, Samuel K ; Wu, J. ; May, R. ; Liu, H. ; Ramos, C. A. ; Carrum, G. ; Heslop, H. E. ; Brenner, M. K. ; Kamble, R. T. / Efficacy of deferred dosing of granulocyte colony-stimulating factor in autologous hematopoietic transplantation for multiple myeloma. In: Bone Marrow Transplantation. 2014 ; Vol. 49, No. 2. pp. 219-222.
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