Konuma Takaaki, Fujioka Machiko, Fuse Kyoko, Hosoi Hiroki, Masamoto Yosuke, Doki Noriko, Uchida Naoyuki, Tanaka Masatsugu, Sawa Masashi, Nishida Tetsuya, Ishikawa Jun, Asada Noboru, Nakamae Hirohisa, Hasegawa Yuta, Onizuka Makoto, Maeda Takeshi, Fukuda Takahiro, Kawamura Koji, Kanda Yoshinobu, Ohbiki Marie, Atsuta Yoshiko, Itonaga Hidehiro
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
Transplant Cell Ther. 2025 Jun;31(6):388.e1-388.e14. doi: 10.1016/j.jtct.2025.03.010. Epub 2025 Mar 17.
Granulocyte colony-stimulating factor (G-CSF) accelerates neutrophil recovery after allogeneic hematopoietic cell transplantation (HCT). However, the optimal use of G-CSF and the timing of its initiation after allogeneic HCT for myelodysplastic syndrome (MDS) according to graft type have not been determined. This retrospective study aimed to investigate the effects of using G-CSF administration and the timing of its initiation on transplant outcomes in adult patients with MDS undergoing allogeneic HCT. Using Japanese registry data, we retrospectively investigated the effects of G-CSF administration and the timing of its initiation on transplant outcomes among 4140 adults with MDS after bone marrow transplantation (BMT), peripheral blood stem cell transplantation (PBSCT), or single-unit cord blood transplantation (CBT) between 2013 and 2022. Multivariate analysis showed that early (days 0 to 4) and late (days 5 to 10) G-CSF administration significantly accelerated neutrophil recovery compared with no G-CSF administration following BMT, PBSCT, and CBT, but there was no benefit of early G-CSF initiation for early neutrophilic recovery regardless of graft type. Late G-CSF initiation was significantly associated with a higher risk of overall chronic GVHD following PBSCT (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.18 to 2.24; P = .002) and CBT (HR, 2.09; 95% CI, 1.21 to 3.60; P = .007) compared with no G-CSF administration. Late G-CSF initiation significantly improved OS compared with no G-CSF administration only following PBSCT (HR, 0.74; 95% CI, 0.58 to 0.94; P = .015). However, G-CSF administration and the timing of its initiation did not affect acute GVHD, relapse, or non-relapse mortality, irrespective of graft type. These results suggest that G-CSF administration significantly accelerated neutrophil recovery after BMT, PBSCT, and CBT, but increased risk of overall chronic GVHD after PBSCT and CBT. However, the effect of early and late G-CSF initiation on transplant outcomes needs further study in adult patients with MDS.
粒细胞集落刺激因子（G-CSF）可加速异基因造血细胞移植（HCT）后中性粒细胞的恢复。然而，对于骨髓增生异常综合征（MDS）患者，根据移植类型确定G-CSF的最佳使用方法及其在异基因HCT后的起始时机尚未明确。这项回顾性研究旨在调查使用G-CSF及其起始时机对接受异基因HCT的成年MDS患者移植结局的影响。利用日本登记数据，我们回顾性调查了2013年至2022年间4140例接受骨髓移植（BMT）、外周血干细胞移植（PBSCT）或单单位脐带血移植（CBT）的成年MDS患者中，G-CSF的使用及其起始时机对移植结局的影响。多变量分析显示，与BMT、PBSCT和CBT后未使用G-CSF相比，早期（第0至4天）和晚期（第5至10天）使用G-CSF可显著加速中性粒细胞恢复，但无论移植类型如何，早期起始G-CSF对早期中性粒细胞恢复均无益处。与未使用G-CSF相比，PBSCT（风险比[HR]，1.63；95%置信区间[CI]，1.18至2.24；P = 0.002）和CBT（HR，2.09；95%CI，1.21至3.60；P = 0.007）后晚期起始G-CSF与总体慢性移植物抗宿主病（GVHD）风险较高显著相关。与未使用G-CSF相比，仅在PBSCT后晚期起始G-CSF显著改善了总生存期（OS）（HR，0.74；95%CI，0.58至0.94；P = 0.015）。然而，无论移植类型如何，G-CSF的使用及其起始时机均不影响急性GVHD、复发或非复发死亡率。这些结果表明，G-CSF的使用可显著加速BMT、PBSCT和CBT后中性粒细胞的恢复，但会增加PBSCT和CBT后总体慢性GVHD的风险。然而，早期和晚期起始G-CSF对成年MDS患者移植结局的影响仍需进一步研究。
