Jackson Emily R, Jared Jason R, Piccolo Jennifer K, Woo Kaitlin M, Mably Mary S, Reed Michael P, Callander Natalie S
1 UW Health, Madison, USA.
2 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
J Oncol Pharm Pract. 2019 Jul;25(5):1135-1141. doi: 10.1177/1078155218781888. Epub 2018 Jun 11.
To evaluate a single institution's experience with granulocyte colony-stimulating factor after autologous hematopoietic stem cell transplant in myeloma patients to identify populations that benefit most from granulocyte colony-stimulating factor administration.
Retrospective chart reviews were conducted on patients 18+ years with multiple myeloma that underwent autologous hematopoietic stem cell transplant at UW Health from January 2012 to May 2016. Data collection included demographics, length of stay, time to engraftment, Eastern Cooperative Oncology Group performance status score, and hematopoietic cell transplantation-comorbidity index. The primary outcome was days from transplant to engraftment, defined as absolute neutrophil count > 500/mm for two consecutive days or absolute neutrophil count > 1000/mm once. A subset analysis was performed on patients whose date of engraftment was known.
In total, 216 individual patients were included in the full cohort and 122 patients included in the subset analysis. Median time to engraftment between patients administered granulocyte colony-stimulating factor and the nongranulocyte colony-stimulating factor group was 12 versus 19 days (P < 0.001) in the full cohort and 12 versus 14 days (P < 0.001) in the subset analysis. The average length of stay posthematopoietic stem cell transplant in the granulocyte colony-stimulating factor group was 15 days versus 17 days in the nongranulocyte colony-stimulating factor group (P = 0.026) in the subset analysis. Additionally, no difference in time to engraftment was seen when stratified by age, Eastern Cooperative Oncology Group performance status score, or hematopoietic cell transplantation-comorbidity index.
Our study supports use of granulocyte colony-stimulating factor posthematopoietic stem cell transplant in myeloma patients to decrease time to engraftment and length of stay. Consideration should be given to utilization in all patients in this population posthematopoietic stem cell transplant. Further research is needed to identify the populations that benefit most from granulocyte colony-stimulating factor administration.
评估一家机构在骨髓瘤患者自体造血干细胞移植后使用粒细胞集落刺激因子的经验，以确定最能从粒细胞集落刺激因子给药中获益的人群。
对2012年1月至2016年5月在威斯康星大学健康中心接受自体造血干细胞移植的18岁及以上多发性骨髓瘤患者进行回顾性病历审查。数据收集包括人口统计学、住院时间、植入时间、东部肿瘤协作组体能状态评分和造血细胞移植合并症指数。主要结局是从移植到植入的天数，定义为连续两天绝对中性粒细胞计数>500/mm³或绝对中性粒细胞计数>1000/mm³一次。对植入日期已知的患者进行了亚组分析。
全队列共纳入216例个体患者，亚组分析纳入122例患者。在全队列中，接受粒细胞集落刺激因子治疗的患者与未接受粒细胞集落刺激因子治疗的患者之间的中位植入时间分别为12天和19天（P<0.001），在亚组分析中分别为12天和14天（P<0.001）。在亚组分析中，粒细胞集落刺激因子组造血干细胞移植后的平均住院时间为15天，未接受粒细胞集落刺激因子治疗的组为17天（P=0.026）。此外，按年龄、东部肿瘤协作组体能状态评分或造血细胞移植合并症指数分层时，植入时间未见差异。
我们的研究支持在骨髓瘤患者造血干细胞移植后使用粒细胞集落刺激因子，以减少植入时间和住院时间。该人群所有造血干细胞移植后的患者均应考虑使用。需要进一步研究以确定最能从粒细胞集落刺激因子给药中获益的人群。
