Use of concurrent G-CSF + GM-CSF vs G-CSF alone for mobilization of peripheral blood stem cells in children with malignant disease

Abstract

There is limited experience in the mobilization of peripheral blood progenitor cells (PBPC) in children and the optimal method for PBPC mobilization is unknown. The present study was conducted to ascertain whether mobilization with G-CSF + GM-CSF (group I) provides some advantage over G-CSF alone (group II) in terms of collected CD34⁺ cells and hematopoietic recovery following myeloablative conditioning in children with malignancies. An economic analysis was also performed. Each group comprised 21 consecutive patients. The mean number of aphereses was 1.5 ± 0.5 in group I and 1.2 ± 0.46 in group II (NS). The mean number of CD34⁺ cells was 3.8 × 10⁶ ± 4.03/kg in group I and 4.2 ± 5.4 in group II (NS). The mean number of total blood volumes (TBV) processed was 4.4 ± 1.5 in group I and 4.3 ± 1.5 in group II (NS). The mean duration of the procedure was 276 ± 74.1 min in group I and 286.7 ± 75.9 min in group II (NS), and the inlet flow was 45.1 ± 12 ml/min in group I and 39.5 ± 15.1 ml/min in group II (NS). No significant differences in the neutrophil and platelet engraftment probability were observed between the two groups. The mean overall cost of group II was not statistically significant from that of group I (US$ 9521 ± 330 vs US$ 10201 ± 1028, P = NS). The cost of mobilization was significantly higher in group I than in group II, conditioning regimen costs were similar in both groups and the costs related to the post-transplant period were similar in both groups. We conclude that PBPC mobilization with G-CSF + GM-CSF in children does not enhance hematological recovery in comparison with mobilization using G-CSF alone. However, the combination of G-CSF + GM-CSF does not significantly increase the overall cost of transplantation. Bone Marrow Transplantation (2000) 26, 365–369.