Revisiting G-CSF Support for Hematologic Recovery after Autologous Transplantation in AML Patients

In acute myeloid leukemia (AML) patients, using granulocyte colony-stimulating factor (G-CSF) to support hematologic recovery in induction and consolidation treatment reduces the number of febrile episodes and the duration of neutropenia and hospitalization. However, the benefit and safety of administering G-CSF to enhance hematologic recovery in AML patients after autologous stem cell transplantation (ASCT) have not been reported so far. At our center, it was our policy to administer G-CSF after ASCT in all AML patients. In June 2015, increasing economic pressure prompted us to omit G-CSF after ASCT. In this retrospective study, we assessed the effects of changing our strategy from applying G-CSF for hematologic recovery after ASCT (in 103 AML patients) to omitting G-CSF (12 patients). We found that administering G-CSF shortened the median duration until neutrophil recovery was >0.5 G/l after ASCT by four days (P=.0001), and patients with G-CSF tended to have fewer bacteremias (38.3% versus 66.6%; P=.0654). The median duration of hospitalization was two days longer in patients without G-CSF support (25 versus 23 days; P=.0603). According to the Swiss in-patient reimbursement system, the shorter hospitalization of +G-CSF patients resulted in decreased total costs per patient of 3305 CHF (48 Mio U of G-CSF), and 3367 CHF (30 Mio U). Finally, no differences were observed in disease free (P=.0938) and overall survival (P=.7999) rates between +G-CSF versus –G-CSF patients. Our data suggest that G-CSF support after ASCT is safe and associated with shorter time until neutrophil recovery, fewer bacteremia episodes, shorter hospitalization, and lower costs. Keywords: Autologous; Transplant; AML; Leukemia; Recovery; Prognosis; Survival; Granulocyte-colony Stimulating factor; G-CSF; Consolidatio