We conducted a prospective, multicenter, open-label randomized trial to compare the antifungal effect of Recombinant Human Granulocyte-macrophage Stimulating Factor (rhGM-CSF), Recombinant Human Granulocyte Stimulating Factor (rhG-CSF) or a combination of rhGM-CSF and rhG-CSF for neutropenic patients undergoing allogeneic stem cell transplantation.
From Sept 2009 to Dec 2012, we recruited consecutive patients with hematological diseases undergoing allogeneic stem cell transplantation at 5 institutions in China. Recipients between ages of 14 to 60 years old were eligible. Eligible patients were randomized to receive once daily subcutaneous 5-7μg/kg/d GM-CSF (Molgramostim, TOPLEUCON®; Xiamen Amoytop Biotech Co., Ltd., China) (GM-CSF group), 5-7μg/kg/d G-CSF (G-CSF group), or a combination of 2-3μg/kg/d GM-CSF and 2-3μg/kg/d G-CSF each (G-CSF+GM-CSF group). Administration of CSFs was started on day 5 post-transplant and continued until recovery from neutropenia (absolute neutrophil count \[ANC\] \> 1.5×10(9)/L for 2 consecutive days). If absolute neutrophil count (ANC) decreased to \< 1.5×10(9)/L within 5 days after withdrawal of CSFs, the same CSF would be resumed until the absolute neutrophil count (ANC) reached 1.5×10(9)/L again. All patients received antimicrobial prophylaxis with oral levofloxacin 500 mg daily and antifungal prophylaxis with oral fluconazole 200 mg daily.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
206
subcutaneous rhGM-CSF 5-7μg/kg/d , started on day 5 post-transplant and continued until recovery from neutropenia (absolute neutrophil count \[ANC\] \> 1.5×10(9)/L for 2 consecutive days).
a combination of 2-3μg/kg/d rhGM-CSF and 2-3μg/kg/d rhG-CSF each after transplantation, started on day 5 post-transplant and continued until recovery from neutropenia (absolute neutrophil count \[ANC\] \> 1.5×10(9)/L for 2 consecutive days).
subcutaneous rhGM-CSF 5-7μg/kg/d , started on day 5 post-transplant and continued until recovery from neutropenia (absolute neutrophil count \[ANC\] \> 1.5×10(9)/L for 2 consecutive days).
The First Affiliated Hospital of Guangxi Medical University
Nanning, Guangxi, China
Henan Cancer Hospital
Zhengzhou, Henan, China
Wuhan Tongji Hospital
Wuhan, Hubei, China
Shanghai First People's Hospital
Shanghai, Shanghai Municipality, China
Incidences of Invasive Fungal Diseases (IFD)
The incidence of proven and probable Invasive fungal diseases (IFD) within 100 days post transplantation
Time frame: 100 day post transplant
Hematological Engraftment
The median time of neutrophil and platelet recovery .
Time frame: 100 days post transplant
Transplant Related Mortality
Transplant related mortality within 100 days after Allogeneic Stem Cell Transplantation (Allo-HSCT).
Time frame: 100 days post transplant
Incidence of Ⅱ- Ⅳ Acute Graft Versus Host Disease (aGVHD)
Incidence of Ⅱ- Ⅳacute graft versus host disease (aGVHD) within 100 days after allogeneic stem cell transplantation (Allo-HSCT).The severity of acute GVHD in the three main target organs (skin, liver, gastrointestinal tract) was assigned stage 1 to 4 based on accepted criteria (Consensus Conference on Acute GVHD Grading).
Time frame: 100 days post transplant
IFD Related Mortality
IFD-related mortalities after a median follow-up of 600 days.
Time frame: 3-1099 days
Relapse Related Mortality
Relapse related mortality after a median follow-up of 600 days.
Time frame: 3~1099 days
Graft Versus Host Disease (aGVHD) Related Mortality
Graft versus host disease (aGVHD) related mortality after a median follow-up of 600 days .
Time frame: 3-1099 days
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The First Affiliated Hospital of Xinjiang Medical University
Ürümqi, Xinjiang, China
Hemorrhage Related Mortality
Hemorrhage related mortality after a median follow-up of 600 days
Time frame: 3-1099 days
Infection Related Mortality
Infection related mortality after a median follow-up of 600 days.
Time frame: 3~1099 days)