A comparison of therapeutic schedules for administering granulocyte colony-stimulating factor to nonhuman primates after high-dose chemotherapy

Granulocyte colony-stimulating factor (G-CSF) has been shown to be effective in clinical trials for reducing the period of neutropenia after chemotherapy. In this study, we compared the timing for initiating G-CSF administration after chemotherapy with the duration of neutropenia and hematopoietic regeneration. Nonhuman primates treated with high-dose chemotherapy (mechloroethamine, 1.5 mg/kg, intravenously) and not administered G-CSF therapy experienced 8 days of neutropenia (absolute neutrophil count [ANC] <1,000/mm³) and had an ANC nadir of 124 ± 64/mm³ at day 7. Monkeys receiving G-CSF (5 μg/kg/d, subcutaneously) began treatment on either days 1, 3, 5, or 7 after chemotherapy. Monkeys treated with G-CSF had an earlier ANC recovery and the number of days with an ANC <500/ mm³ and ANC <1,000/mm³ was reduced by approximately 50% in all treatment strategies. All G-CSF-treated animals, irrespective of the time that G-CSF was initiated, reached an ANC of 10,000/mm³ on day 13 ± 1 day after chemotherapy. These results demonstrated that the duration of G-CSF therapy was almost twice as long for monkeys treated on day 1 as it was for monkeys that received therapy beginning on day 7. A comparison of the results for all treated monkeys identified a distinct difference in the responses of monkeys treated on day 1 from that of animals treated with G-CSF at later times. G-CSF initiated 1 day after chemotherapy led to an earlier onset of neutropenia and a more rapid and augmented recovery of myeloid progenitor cells in the peripheral blood when compared with control and delayed therapy groups. This study demonstrates that neutropenia due to a single dose of mechloroethamine can be equally reduced with both early and delayed initiation of G-CSF. Further, initiating G-CSF therapy after 7 days required approximately 50% less days of therapy to reach an appropriate termination point. The applicability of these findings to other chemotherapy regimens and for repeated cycles is uncertain and needs to be further evaluated. This is a US government work. There are no restrictions on its use.