Elevation of White Blood Cell Count After G-CSF-Combined Conditioning Predicts Relapse and Disease-Free Survival Following Single-Unit Cord Blood Transplantation for Myeloid Malignancies.
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BACKGROUND: Granulocyte colony-stimulating factor (G-CSF) enhances the cytotoxicity of cytarabine (Ara-C) against myeloid leukemia cells, and G-CSF-combined conditioning regimens have been adopted in single-unit cord blood transplantation (CBT) at our institution. However, it remains unclear whether the degree of white blood cell (WBC) elevation during G-CSF administration predicts transplant outcomes. METHODS: We retrospectively analyzed 175 adult patients with myeloid malignancies who underwent first single-unit CBT with myeloablative conditioning (total body irradiation 12 Gy, high-dose Ara-C with G-CSF, and cyclophosphamide) at our institution between 2000 and 2024. The G-CSF priming effect was evaluated by the ratio and absolute difference in WBC counts before and after G-CSF administration. Patients were stratified into higher and lower groups based on receiver operating characteristic curve-derived cutoffs (WBC ratio ≥2.0, WBC difference ≥4.0 × 10⁹/L). RESULTS: Disease-free survival (DFS) was significantly higher in patients with a higher WBC ratio (71.5% versus 53.6% at 5 years, P = .001) and higher WBC difference (75.9% versus 57.9% at 5 years, P = .0009). In multivariate analysis, a higher WBC ratio was independently associated with improved DFS (HR, 0.58, 95% CI, 0.36 to 0.96, P = .035) and reduced relapse (HR, 0.46, 95% CI, 0.23 to 0.92, P = .028). A higher WBC difference was also associated with reduced relapse (HR, 0.44, 95% CI, 0.19 to 0.99, P = .049). Neither WBC parameter was associated with non-relapse mortality or engraftment. Notably, the beneficial effects of higher WBC ratio and difference were confined to patients with high or very high risk of the refined Disease Risk Index. CONCLUSIONS: Elevation of WBC counts during G-CSF-combined conditioning predicts favorable outcomes after single-unit CBT, particularly in patients with high-risk myeloid malignancies.