Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) as an Adjunct to Autologous Hemopoietic Stem Cell Transplantation for Lymphoma
| Autor: | Lamborn Kr, Bonnem Em, Fleming Nc, Blume Kg, Peter L. Greenberg, Nelson J. Chao, R. Advani, Ahn Dk, Sandra J. Horning |
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| Rok vydání: | 1992 |
| Předmět: |
Adult
Male Lymphoma medicine.medical_treatment Hematopoietic stem cell transplantation Colony-Forming Units Assay Double-Blind Method Actuarial Analysis Sargramostim Internal Medicine medicine Humans Prospective Studies Bone Marrow Transplantation Proportional Hazards Models business.industry Hematopoietic Stem Cell Transplantation Granulocyte-Macrophage Colony-Stimulating Factor General Medicine Immunotherapy Middle Aged medicine.disease Combined Modality Therapy Recombinant Proteins Transplantation Haematopoiesis Treatment Outcome Granulocyte macrophage colony-stimulating factor medicine.anatomical_structure Immunology Female Bone marrow business medicine.drug |
| Zdroj: | Annals of Internal Medicine. 116:183 |
| ISSN: | 0003-4819 |
| DOI: | 10.7326/0003-4819-116-3-183 |
| Popis: | To determine the hemopoietic effects of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients having autologous hemopoietic stem cell transplantation for Hodgkin or non-Hodgkin lymphoma.Placebo or GM-CSF was administered after bone marrow or peripheral blood stem cell transplantation or both in a randomized, double-blind phase III trial by daily intravenous infusion (10 micrograms/kg body weight) until absolute neutrophil counts reached greater than or equal to 1000/mm3 on 3 consecutive days.Bone marrow transplantation unit in a university hospital.Sixty-nine consecutive patients with Hodgkin or non-Hodgkin lymphoma received GM-CSF (36 patients) or placebo (33 patients).Patients who received GM-CSF achieved absolute neutrophil counts greater than or equal to 500/mm3 (median, 12 compared with 16 days, P = 0.02) and absolute neutrophil counts greater than or equal to 1000/mm3 (median, 15 compared with 24 days, P less than 0.001) more quickly than patients who received placebo. Multivariate analysis indicated that use of GM-CSF, peripheral blood stem cells, and unpurged bone marrow were the strongest predictors for early neutrophil recovery greater than 500/mm3. Bacterial infections were significantly reduced in the GM-CSF group (P = 0.04). Delayed engraftment (neutrophils less than 500/mm3 at day 30) occurred in 26% and 17% of the placebo and GM-CSF groups, respectively, and correlated with the absence of detectable myeloid progenitor cells (colony-forming units-granulocyte macrophage, CFU-GM) (P less than 0.001) in marrow aspirate specimens obtained on day 15. Time to platelet independence, duration of hospital stay, severe adverse reactions, relapse, and disease-free survival rates did not differ significantly between the two groups.Administration of GM-CSF after autologous hemopoietic stem cell transplantation in patients with lymphoma resulted in accelerated myeloid recovery, particularly in patients who received peripheral blood stem cells and nonpurged bone marrow, and was associated with a decreased incidence of bacterial infections. |
| Databáze: | OpenAIRE |
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