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Since the two growth factors mobilize different cells, concurrent or sequential administration of these growth factors may be synergistic. Spitzer et al.30 conducted a randomized study comparing G-CSF plus GM-CSF each at 5 ^g/kg per day with G-CSF 10 ^g/kg per day for stem cell mobilization in 50 patients with lymphoma and solid tumors. There were no statistically significant differences in either the CD34+ cell yield or the rate of hematopoietic recovery between the two groups. Winter et al.31 conducted a phase I/II study of combined G-CSF and GM-CSF either sequential, G-CSF followed by GM-CSF or GM-CSF followed by G-CSF, or concurrent G-CSF/GM-CSF for mobilization of PBSC. The administration of G-CSF to patients already receiving GM-CSF results in 80-fold increase in HPC over the baseline; however, the addition of GM-CSF to G-CSF was less effective.

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