Abstract

Background: GM-CSF is thought to be beneficial in SCT patients with IFI. The impact of GM-CSF in SCT recipients with GVHD and IFI was evaluated

Methods: A retrospective case-matched (GM-CSF [n = 12] vs. no GM-CSF [n = 27]) study was undertaken to compare outcomes if IFIs diagnosed >100 days following transplantation during 2000–2006. A response was defined as complete or partial response (CR/PR) and considered 3 months after IFI diagnosis or earlier in patients with earlier response. All value are given as median ± s.d. The systemic antifungal therapy in > 60% of patients included echinocandin and anti-mold triazole, or polyene agent.

Results: Please refer to the table below. Patients who received GM-CSF were younger (age 36 ± 17 vs. 51 ± 13 years); neutropenic (<500 cells/uL) at onset of infection (50% vs. 11%; P = 0.014); had lower monocyte counts (10 ± 236 vs. 220 ± 575 cells/uL; P = 0.021) and frequently required intensive care unit stay (50% vs 15%; P = 0.043). A 50% response was observed in the GM-CSF treated SCT recipients with GVHD and IFIs, whereas, 41% response occurred in the group who received no concurrent Gm-CSF (P = 0.6). Similarly, IFI-associated deaths were less frequently observed in GM-CSF treated patients (41%) compared with 55% seen in patients who had not received GM-CSF (P = 0.7). There was a slight increase in survival among SCT recipients treated with GM-CSF (48 ± 21 days vs. 34 ± 19 days in no GM-CSF group P = 0.05)

Conclusions: Late fungal infections in SCT recipients with GVHD, when treated with GM-CSF-based therapy had comparable outcomes despite having significantly more neutropenia, severe monocytopenia and ICU stay.

Characteristics GM-CSF N = 12 (5% No GM-CSF N = 27 (%) p-value 
Underlying Disease-Leukemia Relapsed/refractory Cancer 10 (83) 5 (42) 18 (67) 6 (22) 0.12 0.26 
Proven and probable IFI 9 (75) 21 (78) 
GVHD (extensive) 5 (42) 14 (52) 0.57 
High Dose Steroids 7 (58) 18 (67) 0.72 
Disseminated IFI 3 (25) 4 (15) 0.65 
Breakthrough IFI 10 (83) 25 (93) 0.57 
APACHI II Score at time of IFI diagnosis 11+/−4 (range 5–18) 12+/−3 (range 5–19) 0.47 
Characteristics GM-CSF N = 12 (5% No GM-CSF N = 27 (%) p-value 
Underlying Disease-Leukemia Relapsed/refractory Cancer 10 (83) 5 (42) 18 (67) 6 (22) 0.12 0.26 
Proven and probable IFI 9 (75) 21 (78) 
GVHD (extensive) 5 (42) 14 (52) 0.57 
High Dose Steroids 7 (58) 18 (67) 0.72 
Disseminated IFI 3 (25) 4 (15) 0.65 
Breakthrough IFI 10 (83) 25 (93) 0.57 
APACHI II Score at time of IFI diagnosis 11+/−4 (range 5–18) 12+/−3 (range 5–19) 0.47 

Disclosures: Safdar:cubist: Honoraria; Bayer: Research Funding. Off Label Use: GM-CSF in patients with invasive fungal infection.

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