(142) Impact of Removing GCSF on Hematopoietic Allogeneic Stem Cell Transplantation Outcomes

Poster Abstract:

Background:
Granulocyte colony stimulating factor (GCSF) products are often administered following allogeneic hematopoietic stem cell transplant (alloHCT) to decrease time to neutrophil recovery. Recent literature displayed conflicting data and an unclear benefit in this practice as GCSF administration was not correlated with improvements in treatment related mortality (TRM), overall survival (OS), or leukemia free survival (LFS). Additionally, there were mixed results regarding improved hospital length of stay (LOS), infection risk, and incidence of GVHD. Due to the high costs associated with GCSF administration and the results of these previous studies, our institution has transitioned towards removing GCSF post-alloHCT in all patients, with some exceptions, starting April 2021.

A previous iteration of this study which included 137 patients showed that post-transplant administration of GCSF amongst alloHCT recipients did not show a significant difference in length of hospital stay. The study investigators concluded that a larger sample size is needed to adequately power the study and detect differences in outcomes between subgroups.

Objective:
This study will evaluate the impact of removing routine GCSF on post-allogeneic stem cell transplant outcomes including length of stay in addition to safety and efficacy outcomes following alloHCT.

METHODS
This is a single-center, retrospective cohort study of patients at UCSF Health, a National Cancer Institute designated cancer center. This study will retrospectively analyze patient medical records of all adult patients (at least 18 years old) receiving alloHCT between January 2017 to December 2022. Exclusion criteria includes recipients of haploidentical stem cell transplant, post-transplant cyclophosphamide, more than 1 stem cell transplant, aplastic anemia diagnosis, and/or history of chimeric antigen receptor (CAR) T-cell therapy.

We will determine the impact of GCSF administration post-alloHCT on patient’s length of stay in addition to safety and efficacy outcomes following alloHCT including time to neutrophil engraftment, days of total parenteral nutrition (TPN) use, days of patient-controlled analgesia (PCA) use, number of supportive transfusions, eltrombopag use, hospital readmission, incidence of infections, treatment related mortality (TRM), and overall survival (OS).

RESULTS
Data collection is in progress.

CONCLUSIONS/DISCUSSION
Discussion is in progress.

References (must also be included in final poster): 1. Ringdén O, Labopin M, Gorin NC, et al. Treatment with granulocyte colony-stimulating factor after allogeneic bone marrow transplantation for acute leukemia increases the risk of graft-versus-host disease and death: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol. 2004;22(3):416-423. doi:10.1200/JCO.2004.06.102 

2. George G, Martin ASt, Chhabra S, et al. The Effect of Granulocyte Colony-Stimulating Factor Use on Hospital Length of Stay after Allogeneic Hematopoietic Cell Transplantation: A Retrospective Multicenter Cohort Study. Biol Blood Marrow Transplant. 2020;26(12):2359-2364. doi:10.1016/j.bbmt.2020.08.013 

3. Khoury HJ, Loberiza FR, Ringdén O, et al. Impact of posttransplantation G-CSF on outcomes of allogeneic hematopoietic stem cell transplantation. Blood. 2006;107(4):1712-1716. doi:10.1182/blood-2005-07-2661 

4. Gupta AK, Meena JP, Haldar P, et al. Impact of G-CSF administration post-allogeneic hematopoietic stem-cell transplantation on outcomes: a systematic review and meta-analysis. Am J Blood Res. 2021;11(5):544-563. Published 2021 Oct 15. 

5. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488 

6. Godara A, Siddiqui NS, Munigala S, et al. Length of Stay and Hospital Costs for Patients Undergoing Allogeneic Stem-Cell Transplantation. JCO Oncol Pract. 2021;17(3):e355-e368. doi:10.1200/OP.20.00170 

7. Orfali N, Zhang MJ, Allbee-Johnson M, et al. Planned granulocyte-colony stimulating factor adversely impacts survival after allogeneic hematopoietic cell transplantation performed with Thymoglobulin for myeloid malignancy. Transplantation and cellular therapy. 2021;27(12):993.e1-993.e8. doi:https://doi.org/10.1016/j.jtct.2021.08.031