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Blood, 1 April 2007, Vol. 109, No. 7, pp. 2794-2796.
Prepublished online as a Blood First Edition Paper on November 16, 2006; DOI 10.1182/blood-2006-07-034272.


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CLINICAL TRIALS AND OBSERVATIONS

Brief Report

Granulocyte-stimulating factor and severe aplastic anemia: a survey by the European Group for Blood and Marrow Transplantation (EBMT)

Gerard Socie1, Jean-Yves Mary2, Hubert Schrezenmeier3, Judith Marsh4, Andrea Bacigalupo5, Anna Locasciulli6, Monica Fuehrer7, Albert Bekassy8, Andre Tichelli9, and Jakob Passweg10

1 Service d'Hématologie Greffe, and Institut National de la Santé et de la Recherche Médicale (INSERM) U728, Hospital Saint Louis, Paris, France; 2 INSERM U717, University Paris VII, and Département de Biostatistique et Informatique Médicale (DBIM) Hospital Saint Louis, Paris, France; 3 University of Ulm, Institute for Transfusion Medicine, and Institut für Klinische Transfusionmedizin und Immunogenetik (IKT) Ulm, Ulm, Germany; 4 Hematology, Saint George Hospital, London, United Kingdom; 5 Department of Hematology, Hospital San Martino, Genova, Italy; 6 Department of Hematology, Hospital San Camillo, Rome, Italy; 7 Children Hospital, University of Munich, Munich, Germany; 8 Department of Hematology, University Hospital, Lund, Sweden; 9 Department of Hematology, University Hospital, Basel, Switzerland; 10 Department of Hematology, Geneva Hospital, Geneva, Switzerland

Previous studies suggested a link between the use of G-CSF and increased incidence of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) after immunosuppressive therapy (IST) for severe aplastic anemia (SAA). This European survey included 840 patients who received a first-line IST with (43%) or without (57%) G-CSF. The incidences of MDS/AML in patients who did or did not receive G-CSF were 10.9% and 5.8%, respectively. A significantly higher hazard (1.9) of MDS/AML was associated with use of G-CSF. Relapse of aplastic anemia was not associated with a worse outcome in patients who did not receive G-CSF as first therapy, whereas relapse was associated with a significantly worse outcome in those patients who received G-CSF. These results emphasize the necessity of the current European randomized trial comparing IST with or without G-CSF and to alert physicians that adding G-CSF to IST is currently not standard treatment for SAA.


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