Administration of G-CSF plus dexamethasone produces greater granulocyte concentrate yields while causing no more donor toxicity than G-CSF alone

被引:62
作者
Stroncek, DF [1 ]
Yau, YY [1 ]
Oblitas, J [1 ]
Leitman, SF [1 ]
机构
[1] NIH, Warren G Magnuson Clin Ctr, Dept Transfus Med, Bethesda, MD 20892 USA
关键词
D O I
10.1046/j.1537-2995.2001.41081037.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: G-CSF with or without dexamethasone is becoming the standard agent for mobilizing granulocytes for transfusion. The purpose of this study was to determine if the toxicities of G-CSF with or without dexamethasone are offset by greater collection yields and to define the minimum interval that should separate sequential collections. STUDY DESIGN AND METHODS: Twenty donors were studied on three occasions. They were given either dexamethasone (8 mg, by mouth) plus a placebo injection, G-CSF (5 mug/kg, given subcutaneously) plus placebo capsules, or G-CSF plus dexamethasone. Granulocytes were collected by apheresis. A donor symptom survey was administered, and cell counts and blood chemistries were assessed before collection and 1, 2, 7, 14, 21, 28, and 35 days after collection. RESULTS: More granulocytes were collected when G-CSF was given than when dexamethasone was given (41.1 +/- 20.4 x 10(9) vs. 21.0 +/- 10.0 x 10(9); p < 0.001), but the use of G-CSF plus dexamethasone produced the greatest yields (67.1 +/- 22.0 x 10(9); p < 0.002). When the donors were given dexamethasone alone, 58 percent experienced at least one symptom, compared to 85 percent of those given G-CSF and 75 percent of those given G-CSF plus dexamethasone. In all three regimens, platelet counts fell 19 percent to 24 percent after collection and remained below baseline for 7 to 14 days. Granulocyte counts returned to baseline within 3 to 7 days, but, in all three regimens, a mild granulocytopenia occurred 21 days after collection. With each of the regimens, blood chemistries changed, but the changes were mild and most returned to baseline within 7 days; however, changes in albumin, bilirubin, and AST persisted until 28 days after collection. CONCLUSION: These results support the use of G-CSF plus dexamethasone in granulocyte donors. G-CSF plus dexamethasone resulted in greater granulocyte yields than either agent alone and was associated with donor symptoms and changes in blood cell counts and chemistries similar to those seen with G-CSF alone or dexamethasone alone. Granulocytes can be safely collected a second time after a 7-day interval; however, for regular donors, it may be best to separate collections by 4 weeks.
引用
收藏
页码:1037 / 1044
页数:8
相关论文
共 21 条
[1]   Transfusions of granulocyte-colony-stimulating factor-mobilized granulocyte components to allogeneic transplant recipients: Analysis of kinetics and factors determining posttransfusion neutrophil and platelet counts [J].
Adkins, D ;
Spitzer, G ;
Johnston, M ;
Velasquez, W ;
Dunphy, F ;
Petruska, P .
TRANSFUSION, 1997, 37 (07) :737-748
[2]   Indium-labeled white blood cells apheresed from donors receiving G-CSF localize to sites of inflammation when infused into allogeneic bone marrow transplant recipients [J].
Adkins, D ;
Goodgold, H ;
Hendershott, L ;
Johnston, M ;
Cravens, D ;
Spitzer, G .
BONE MARROW TRANSPLANTATION, 1997, 19 (08) :809-812
[3]   Effect of leukocyte compatibility on neutrophil increment after transfusion of granulocyte colony-stimulating factor-mobilized prophylactic granulocyte transfusions and on clinical outcomes after stem cell transplantation [J].
Adkins, DR ;
Goodnough, LT ;
Shenoy, S ;
Brown, R ;
Moellering, J ;
Khoury, H ;
Vij, R ;
DiPersio, J .
BLOOD, 2000, 95 (11) :3605-3612
[4]   Transient neutropenia in normal donors after G-CSF mobilization and stem cell apheresis [J].
Anderlini, P ;
Przepiorka, D ;
Seong, D ;
Champlin, R ;
Korbling, M .
BRITISH JOURNAL OF HAEMATOLOGY, 1996, 94 (01) :155-158
[5]   Clinical toxicity and laboratory effects of granulocyte-colony-stimulating factor (filgrastim) mobilization and blood stem cell apheresis from normal donors, and analysis of charges for the procedures [J].
Anderlini, P ;
Przepiorka, D ;
Seong, D ;
Miller, P ;
Sundberg, J ;
Lichtiger, B ;
Norfleet, F ;
Chan, KW ;
Champlin, R ;
Korbling, M .
TRANSFUSION, 1996, 36 (07) :590-595
[6]   THE EFFECTS OF DAILY RECOMBINANT HUMAN GRANULOCYTE COLONY-STIMULATING FACTOR ADMINISTRATION ON NORMAL GRANULOCYTE DONORS UNDERGOING LEUKAPHERESIS [J].
BENSINGER, WI ;
PRICE, TH ;
DALE, DC ;
APPELBAUM, FR ;
CLIFT, R ;
LILLEBY, K ;
WILLIAMS, B ;
STORB, R ;
THOMAS, ED ;
BUCKNER, CD .
BLOOD, 1993, 81 (07) :1883-1888
[7]   Neutrophil transfusions: kinetics and functions of neutrophils mobilized with granulocyte-colony-stimulating factor and dexamethasone [J].
Dale, DC ;
Liles, WC ;
Llewellyn, C ;
Rodger, E ;
Price, TH .
TRANSFUSION, 1998, 38 (08) :713-721
[8]   Collection and transfusion of granulocyte concentrates from donors primed with granulocyte stimulating factor and response of myelosuppressed patients with established infection [J].
Hester, JP ;
Dignani, MC ;
Anaissie, EJ ;
Kantarjian, HM ;
OBrien, S ;
Freireich, EJ .
JOURNAL OF CLINICAL APHERESIS, 1995, 10 (04) :188-193
[9]   Evaluation and comparison of three mobilization methods For the collection of granulocytes [J].
Jendiroba, DB ;
Lichtiger, B ;
Anaissie, E ;
Reddy, V ;
O'Brien, S ;
Kantarjian, H ;
Freireich, EJ .
TRANSFUSION, 1998, 38 (08) :722-728
[10]  
Leitman S. F., 1997, Transfusion (Bethesda), V37, p67S