Use of recombinant GM-CSF following allogeneic BMTs for aplastic anemia

GM-CSF has been used successfully in autologous BMTs, and more recently in patients undergoing allogeneic BMT, for acute or chronic leukemia. We report two patients with hepatitis-related aplastic anemia who received recombinant human GM-CSF following HLA-identical sibling allogeneic BMTs. Both patients were conditioned with CY 200 mg/kg given over 4 days and received GM-CSF at 250 μg/m² beginning 6 h after marrow infusion and continuing daily until the absolute neutrophil count was > 1.0 X 10⁹/l for 2 days. Both patients had prompt engraftment, achieving an absolute neutrophil count of > 0.5 X 10⁹/l on day 13. Neither patient had side-effects attributable to the GM-CSF although one patient developed severe acute GVHD after the cessation of GM-CSF therapy. Our experience suggests that GM-CSF can be safely used in aplastic anemia patients undergoing BMT and that GM-CSF may be useful to decrease the incidence of graft failure associated with less intensive conditioning regimens.