Available data suggest the potential for similar benefits after allogeneic BMT, but these data remain less conclusive and the routine use of CSFs following allogeneic transplantation cannot be strongly encouraged at the present time. Until further trials are performed to specifically determine the value of CSF administration after high-dose chemotherapy and PBPC transplantation, CSF use in this setting seems reasonable. There also may be a role for the CSFs in assisting in the recovery of patients who experience delayed or inadequate neutrophil engraftment following progenitor-cell transplantation.
Available evidence indicates that the CSFs are effective in mobilizing PBPC for transplantation.
The same doses, routes and schedules of CSF administration mentioned in the Guidelines for CSF Dosing and Route of Administration and Guidelines for Initiation and Duration of CSF Administration should be used in the transplantation setting. The major complications of high-dose chemotherapy supported by autologous BMT or PBPC transplantation are disease recurrence, infection, the need for RBC and platelet transfusions, delayed or incomplete engraftment, organ damage from the ablative regimen, prolonged hospitalization, and the high cost of treatment. Clinical Outcomes CSFs have been administered following both autologous and allogeneic BMT in anticipation of reducing the severity of infectious complications, thereby decreasing hospitalization time, reducing costs, and improving quality of life. Use of the CSFs to mobilize PBPC into the circulation for harvesting is expected to enhance progenitor numbers, lessen the frequency, duration, and cost of leukopheresis procedures, and potentially speed hematologic recovery after transplantation of the CSF-mobilized cells. The primary alternatives to administration of CSFs following cytoreduction and progenitor-cell transplantation have been monitoring of temperature and ANC, initiation of antibiotic therapy if a fever develops, and continuation of hospitalization until satisfactory resolution of infection and neutropenia.