Sequential cytokine support following autologous peripheral blood stem cell transplantation may accelerate white blood cell recovery
GM-CSF (sargramostim) and G-CSF (filgrastim) stimulate hematopoietic proliferation and accelerate blood count recovery following chemotherapy. GM-CSF appears to stimulate earlier hematopoietic precursors than G-CSF, suggesting the possibility of concurrent or sequential treatment. Based on this, 27 consecutive breast cancer patients undergoing potentially myeloablative chemotherapy consisting of melphalan (100 mg/m1), thio TEPA (600 mg/mj and carboplatin (1050 mg/m1) prior to autologous hematopoietic stem cell transplantation were given GM-CSF (500 /ig/day) for 7 days beginning on the day of transplantation followed by G-CSF (480 jtg/day) until white blood count (WBC) exceeded 10,000/μl. GM-CSF was given by 2-hour intravenous infusion. G-CSF was given by intravenous push. All patients received G-CSF mobilized peripheral blood derived hematopoietic stem cells. WBC and platelet recovery in these patients (Figures 1 and 2) were uniformly prompt and the rate of WBC recovery from 500 to 10,000/μl appears superior to thai of patients previously treated with either GM or G-CSF alone (data not shown). Based on these findings, a randomized study is underway comparing sequential GM-CSF/G-CSF with G-CSF alone.