Comparison of G-CSF Administration Starting Day +5 Versus Based on White Blood Count Following Autologous Peripheral Blood Stem Cell Transplantation.

Granulocyte colony stimulating factor (G-CSF) is commonly used following autologous peripheral blood stem cell transplantation (PBSCT) to promote bone marrow recovery. However, the optimal timing of G-CSF in this setting is unknown. We randomized 23 patients undergoing autologous PBSCT for a variety of malignant disorders to G-CSF administration 5 μg/kg/day starting day +5 (Arm A) versus when white blood count (WBC) recovered to 0.2 x 10⁹/L or 0.1 x 10⁹/L for 2 consecutive days (Arm B). Results: All patients engrafted. The median time to absolute neutrophil count (ANC) > 1.0 x 10⁹/L in Arms A and B was 12.1 vs. 12.8 days (p=0.77). There was no significant difference in number of days of temperature >38.3°C (4.3 vs. 4.4 days, p=0.71) or hospital stay (23.8 vs. 22.1 days, p=0.93) between Arms A and B respectively. The mean amount of G-CSF administered was 3210 μg/patient in Arm A vs. 2384 μg/patient in Arm B, a significant reduction (p=0.035). Conclusion: Waiting for early signs of engraftment after autologous PBSCT before starting G-CSF administration is associated with a decrease in amount of G-CSF administration by 25%, with no increase in days with fever, time to neutrophil recovery, or length of hospital stay.