33 research outputs found
Associação entre características de desempenho de tilápia-do-nilo ao longo do período de cultivo
Hematopoietic growth factors after HLA-identical allogeneic bone marrow transplantation in patients treated with methotrexate-containing graft-vs.-host disease prophylaxis
The use of hematopoietic growth factors (HGFs) in the allogeneic transplant setting has sometimes been avoided for fear
of stimulating leukemic cell growth and intensifying graft-vs.-
host disease (GVHD). However, neither an increase in relapse
rate nor an aggravation of GVHD has been routinely
described when HGFs are used after allogeneic bone marrow
transplantation (allo-BMT). Early outcomes after HLAmatched allo-BMT in 26 patients with hematologic malignancies treated with recombinant human granulocyte colonystimulating factor (rhG-CSF) or recombinant human
granulocyte-macrophage colony-stimulating factor (rhGMCSF) from the day of transplantation were analyzed. Results
were compared to those from a series of 38 patients treated
earlier with an identical approach, but not scheduled to
receive HGFs after transplantation. All patients received a
preparative regimen consisting of etoposide, cyclophosphamide, and total-body irradiation and GVHD prophylaxis
with cyclosporine and a short course of methotrexate (MTX).
The analysis has shown that the duration of neutropenia was
significantly decreased in the group of patients treated routinely with HGFs (median 17 vs. 20 days; p < 0.001). These
patients also required fewer days of intravenous antibiotic
therapy (median 20 vs. 34 days; p < 0.001), had fewer positive
blood and tissue cultures (median 2 vs. 12 and 13 vs. 28; p =
0.02 and p = 0.05, respectively), needed fewer packed red
blood cell transfusions (median 7 vs. 11; p < 0.03), and were
discharged earlier from the hospital (median 33.5 vs. 39 days;
p < 0.001). The use of HGFs was not associated with an
increase in acute GVHD or early leukemic relapse. No side
effects were attributable to the simultaneous administration
of MTX and HGF during the neutropenic period. A trend
toward better 100-day actuarial survival for patients treated with rhG-CSF or rhGM-CSF did not reach statistical significance. A decrease in the number of early deaths from fungal
or bacterial infections was found in the cytokine-treated
group (p = 0.05). These data suggest that the early use of rhGCSF or rhGM-CSF after HLA-matched allo-BMT in hematologic malignancies accelerates engraftment, reduces hospitalization time, and improves outcome, without increasing acute
GVHD or early relapse. Because MTX-based prophylaxis regimens are associated with prolonged neutropenia, the routine
use of HGFs after transplantation may be particularly useful in
regimens including MTX