Engraftment Syndrome in Autologous Hematopoietic Cell Transplantation
Creators: name: Nance, Sabrina
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: Granulocyte-colony stimulating factors (G-CSFs) are utilized to decrease the duration of neutropenia following autologous cell transplantation (auto-HCT). G-CSF use increases the risk of developing an inflammatory condition called engraftment syndrome (ES) during neutrophil recovery. ES presents with pleiotropic effects including non-infectious fever, skin rash, and diarrhea and is associated with increased morbidity and mortality rates when left untreated. However, differences in rates of ES and ES-related complications have not been evaluated as a function of specific G-CSF agents. In this study, we sought to evaluate differences in ES incidence and ES-related complications during neutrophil recovery among auto-HCT patients prescribed filgrastim versus tbo-filgrastim.
This was a single-center retrospective cohort study. Baseline demographic and clinical data were manually extracted from the electronic medical record and the UNC Bone Marrow Transplant database. Treatment-related data that were extracted included: type of G-CSF administered, conditioning chemotherapy regimen, underlying cancer diagnosis, total number of pre-transplant cycles of chemotherapy, treatments used for ES and ES-related complications, and additional clinical sequelae (e.g., intensive care unit [ICU] admissions and Clostridioides difficile (C. difficile) diagnoses). Patients with ES were identified based on physician diagnosis in the EMR.
A total of 738 auto-HCT patients were identified and available for analysis, including 256 patients who received filgrastim and 482 patients who received tbo-filgrastim. The median age was 59 years (IQR 49-66). The cohort was predominantly male (n=459, 62.2%), had a multiple myeloma diagnosis (n=450, 60.9%), had undergone a melphalan-based conditioning regimen (n=476, 64.5%). The incidence of ES was similar between patients treated with filgrastim (n=65, 25.4%) versus tbo-filgrastim (n=130, 26.9%; P=0.66). Rates of corticosteroid use were similar between filgrastim and tbo-filgrastim (n=58 and n=111, respectively; P=0.51). Duration of corticosteroid use varied between groups (median 7 vs. 9 days, respectively; P=0.03), but is not clinically significant. Rates of empiric antibiotics used for neutropenic fever were also similar between filgrastim and tbo-filgrastim (n=61 and n=127, respectively; P=0.22), as was duration of antibiotics (median 5 days for both P=0.58). There were no significant differences between the two study arms in terms of C. difficile diagnoses (P=0.56) or ES-related ICU admissions (P=0.17).
Results indicate there may not be a difference in ES incidence or ES-related complications among auto-HCT patients treated with filgrastim compared to tbo-filgrastim during neutrophil recovery. While these results need to be validated with future studies, they provide rationale for the selection of G- CSF based on cost benefits without compromising clinical outcomes in the auto-HCT population regardless of baseline patient clinical characteristics.