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Prevention, treatment of invasive fungal disease in allogeneic stem-cell transplantation recipients
the Oncology Nurse Advisor take:
A team of researchers from Shanghai, China, hypothesized that prophylactic therapy with granulocyte-macrophage colony-stimulating factor (GM-CSF) decreases invasive fungal disease (IFD) in patients undergoing allogeneic hematopoietic stem-cell transplantation (alloHSCT).
They compared once-daily subcutaneous GM-CSF (5 to 7 µg/kg per day), granulocyte colony-stimulating factor (G-CSF; 5 to 7 µg/kg per day), or a combination of G-CSF and GM-CSF (2 to 3 µg/kg per day each).
They randomly assigned 206 patients undergoing alloHSCT to one of the three treatments, which were started on day 5 after transplantation. Treatment was continued until the absolute neutrophil count was ≥1.5x109/L for 2 consecutive days.
The results showed no significant difference in 100-day incidences of proven and probable IFD among the three groups. In the GM-CSF and G-CSF+GM-CSF groups, 100-day cumulative mortality after transplantation and 100-day transplantation-related mortality were lower than in the G-CSF group.
IFD-related mortality was also lower in the GM-CSF and G-CSF+GM-CSF groups after 600 days follow-up, compared with the G-CSF group.
The researchers conclude that prophylactic GM-CSF improves 100-day transplantation-related mortality, 100-day cumulative mortality, and 600-day IFD-related mortality in recipients of alloHSCT, compared with G-CSF.
