The timing of Granulocyte Colony-Stimulating Factor in Hematopoietic Stem Cell Transplant in the Pandemic

INTRODUCTION: Granulocyte-colony stimulating factors (G-CSF) are used to shorten the duration of neutropenia after hematopoietic cell transplantation (HCT). However, there is no consensus on which days treatment should be started post-transplantation during the COVID-19 pandemic. In this study, we looked at the influence of G-CSF on clinical outcomes on the fifth (G-CSFd5) and tenth (G-CSFd10) days following allo-HCT.
METHODS: Our study includes the data of 60 patients (G-CSFd5, n=28 vs G-CSFd10, n=32) who underwent HCT with the diagnosis of acute lymphoblastic leukemia (ALL) between 2015 and 2022. Primary outcome is the effect of G-CSF on hospital stay. Secondary outcomes are the development and duration of febrile neutropenia (FEN), neutrophil engraftment (NE), platelet engraftment (PE), engraftment syndrome (ES), acute graft versus host disease (aGVHD), cytomegalovirus (CMV) viremia, and effects on antimicrobial use.
RESULTS: Length of hospital stay, 34.5 days vs. 30 days (p=0.19); median NE, 13.85 vs 15.03 days (p=0.007); median PE, 15.5 vs 12 days (p=0.12); ES, 28.5% vs 12.5% (p=0.12); FEN, 85.7% vs 84.3% (p=0.88); aGVHD, 39.2% vs 40.6% (p=0.92); were observed for G-CSFd5 and G-CSFd10, respectively.
DISCUSSION AND CONCLUSION: Although starting G-CSF in the early period after allo-HCT shortened the duration of NE, positive effects on clinical outcomes were not observed. On the contrary, the frequency of ES increased in the group that received GCSF early.