PB2360 EARLY VS DELAYED G-CSF IN MULTIPLE MYELOMA AUTOLOGOUS STEM CELL TRANSPLANT

Abstract

Background: Prophylactic use of G-CSF on Day + 6 of PBSC infusion has been the standard of care for Autologous Stem Cell Transplantation. In Multiple Myeloma patients however, this practice has been challenged lately to have doubtful clinical benefits. In latest prospective trials, scheduled use of G-CSF and delayed G-CSF were not different in terms of neutrophil engraftment, febrile neutropenia and infection rates with only modest benefit in hospitalization days. In Indian scenario however, the benefit of reduced cost may not outweigh risks of morbidity and mortality associated with delayed G-CSF Aims: 1. To prospectively analyze patients of Multiple Myeloma undergoing Autologous SCT for neutrophil engarftment with or without prophylactic G-CSF 2. To analyze the risk vs benefit vis a vis prophylactic vs delayed G-CSF in terms of Neutrophil engraftment, incidence and duration of febrile neutropenia, use of empirical antifungal use, hospitalization days and mortality Methods: We conducted a single centre prospective study to find out the kinetics of neutrophil recovery and associated complications of severe neutropenia in 25 patients of Multiple myeloma who underwent Auto SCT with high dose melphalan between Jan,2015 and June,2017. 15 patients received scheduled G-CSF on day + 6 and 10 patients received delayed G-CSF upon first signs of neutrophil recovery or in febrile neutropenia Results: We found out that our patients had faster neutrophil recovery and engraftment (median 11 days) than previous reports with or without scheduled G-CSF. Prophylactic group received a median of 6 doses as compared to a median of 3 doses in the delayed group. However the incidence of febrile neutropenia (6 vs 2; p < 0.01), cumulative duration of febrile neutropenia (18 vs 4 days; p < 0.01), and duration of empirical antifungal use (28 vs 2 days; p < 0.01) were higher in patients with delayed G-CSF. Hospitalization days were also higher in delayed G-CSF (35 vs 24 days; p > 0.05). No deaths were reported. Summary/Conclusion: The results vary from western literature on transplants in myeloma patients. In India where infective complications following high dose therapies are higher, current findings suggest that use of scheduled early G-CSF at D + 6 to hasten neutrophil recovery may be continued for routine practice.