Impact of Granulocyte Colony-Stimulating Factor (G-CSF) on Clinical Outcomes in Allogeneic Hematopoietic Cell Transplantation: Does Speeding Up Neutrophil Engraftment Make a Difference?

Ahmed Alnughmush; Ayman Sayyed; Mats Remberger; Eshrak Al-Shaibani; Carol Chen; Caden Chiarello; Ivan Pasic; Igor Novitzky-Basso; Arjun Datt Law; Wilson Lam; Dennis Dong Hwan Kim; Armin Gerbitz; Auro Viswabandya; Rajat Kumar; Fotios V Michelis; Jonas Mattsson

doi:10.1097/TXD.0000000000001753

Impact of Granulocyte Colony-Stimulating Factor (G-CSF) on Clinical Outcomes in Allogeneic Hematopoietic Cell Transplantation: Does Speeding Up Neutrophil Engraftment Make a Difference?

Transplant Direct. 2025 Jan 9;11(2):e1753. doi: 10.1097/TXD.0000000000001753. eCollection 2025 Feb.

Authors

Ahmed Alnughmush^{1

2

3}, Ayman Sayyed^{1

2

4}, Mats Remberger⁵, Eshrak Al-Shaibani^{1

2}, Carol Chen², Caden Chiarello², Ivan Pasic^{1

2}, Igor Novitzky-Basso^{1

2}, Arjun Datt Law^{1

2}, Wilson Lam^{1

2}, Dennis Dong Hwan Kim^{1

2}, Armin Gerbitz^{1

2}, Auro Viswabandya^{1

2}, Rajat Kumar^{1

2}, Fotios V Michelis^{1

2}, Jonas Mattsson^{1

2

6}

Affiliations

¹ Department of Medicine, University of Toronto, Toronto, ON, Canada.
² Hans Messner Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
³ Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
⁴ Division of Clinical Sciences, Department of Internal Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada.
⁵ KFUE, Uppsala University Hospital, and IMV, Uppsala University, Uppsala, Sweden.
⁶ Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Despite decades of post-allogeneic hematopoietic cell transplantation (HCT) growth factor utilization, its role remains undefined, leading to ongoing debates and research. The theoretical impacts of growth factors have been challenged in numerous studies.

Methods: In this retrospective cohort study conducted at the Princess Margaret Cancer Centre, we analyzed the clinical outcomes of 509 patients who underwent allogeneic HCT between May 1, 2019, and May 31, 2022. This study aimed to assess the impact of granulocyte colony-stimulating factor (G-CSF) administration posttransplantation on neutrophil and platelet engraftment, incidence of bloodstream infections (BSIs), graft-versus-host disease, engraftment syndrome (ES), and survival metrics including overall survival, nonrelapse mortality, and graft-versus-host disease-free/relapse-free survival.

Results: Our findings indicate that G-CSF administration expedited neutrophil engraftment (16 versus 18 d, P = 0.009) and was associated with a decreased incidence of BSI (9.4% versus 31.3%, P = 0.014). However, this benefit was counterbalanced by a significant delay in platelet engraftment (21 versus 17 d, P < 0.001). Multivariate logistic regression analysis identified mismatched donors (odds ratio, 1.72; 95% confidence interval, 1.03-2.88; P = 0.038) and the duration of G-CSF therapy (odds ratio, 1.04; 95% confidence interval, 1.00-1.09; P = 0.038) as independent predictors for the development of ES. Despite these hematological impacts, there was no observed advantage in overall survival, nonrelapse mortality, or graft-versus-host disease-free/relapse-free survival among patients who received G-CSF compared with those who did not.

Conclusions: Although G-CSF post-HCT expedited neutrophil engraftment and reduced BSI risk, it did not result in a survival advantage. The association with ES necessitates careful consideration.