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Successful neutrophil engraftment by reduced use of granulocyte colony-stimulating factor after allogeneic hematopoietic stem cell transplantation with mycophenolate mofetil for graft-versus-host disease prophylaxis

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Abstract

In allogeneic hematopoietic stem cell transplantation (allo-SCT), most physicians in Japan utilize granulocyte colony-stimulating factor (G-CSF) at a high dose (HD) of 300 μg/m2 per day for filgrastim to promote faster neutrophil engraftment. However, the necessity of the HD has not been validated under graft-versus-host disease (GVHD) prophylaxis by mycophenolate mofetil (MMF), which can also be expected to facilitate engraftment. In a total of 51 patients, we compared the clinical outcomes between a standard dose (SD) fixed at 300 μg per day and a HD of G-CSF. While time to neutrophil engraftment was not different in the HD and SD groups in patients receiving cord blood transplantation (CBT, 20 vs. 17.5 days, P = 0.243) or bone marrow transplantation (BMT, 11 vs. 10 days, P = 0.227), there seemed to be an increased risk of developing acute GVHD in the HD group with CBT (20 vs. 0%, P = 0.073) and BMT (57 vs. 24%, P = 0.165). Progression-free survival of patients in the HD group was likely to be worse compared with that of the SD group with CBT (P = 0.099). In this study, the clinical benefits of a HD of G-CSF could not be documented, and we find that the use of G-CSF at a SD after allo-SCT with MMF should be prospectively evaluated.

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Acknowledgments

The authors are very grateful to all the nurses, other medical staff of the stem cell transplantation unit, and physicians of the Hematology Division at Kobe University Hospital. This work was supported in part by Grants-in Aid for Scientific Research from the Ministry of Health, Welfare, and Labor in Japan.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Atsuo Okamura, Kimikazu Yakushijin, Yumiko Inui, Yohei Funakoshi, Yuriko Kawamori, Takanobu Shimada, Masanori Toyoda, Naoko Chayahara, Naomi Kiyota, Yutaka Fujiwara, Toru Mukohara, Hiroshi Matsuoka, Katsuya Yamamoto & Hironobu Minami

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  1. Atsuo Okamura
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  2. Kimikazu Yakushijin
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  3. Yumiko Inui
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  4. Yohei Funakoshi
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  5. Yuriko Kawamori
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  12. Hiroshi Matsuoka
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  13. Katsuya Yamamoto
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  14. Hironobu Minami
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Correspondence to Atsuo Okamura.

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Okamura, A., Yakushijin, K., Inui, Y. et al. Successful neutrophil engraftment by reduced use of granulocyte colony-stimulating factor after allogeneic hematopoietic stem cell transplantation with mycophenolate mofetil for graft-versus-host disease prophylaxis. Int J Hematol 93, 765–770 (2011). https://doi.org/10.1007/s12185-011-0852-5

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  • DOI: https://doi.org/10.1007/s12185-011-0852-5

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