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W. Conrad Liles, Kai Hübel, David C. Dale, Reply, The Journal of Infectious Diseases, Volume 184, Issue 1, 1 July 2001, Pages 117–118, https://doi.org/10.1086/321012
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To the Editor—We appreciate the interest by Koduri [1] in our recent review of granulocyte transfusion therapy [2]. We agree that potential risks of donor mobilization regimens should be considered in granulocyte transfusion programs. Specifically, Koduri cites 2 reports of splenic rupture and 2 reports of acute inflammatory reactions characterized by neutrophilic infiltrates in apparently healthy persons that occurred after granulocyte colony-stimulating factor (G-CSF)–based regimens for harvest of peripheral blood hematopoietic stem cells [3–5 ]. The G-CSF–based hematopoietic stem cell mobilization regimens associated with these adverse events involved serial administration of G-CSF at a dose of 5–16 μg/kg of body weight on a daily basis for 3–5 consecutive days [3–5 ]. These dosages far exceed those generally used for stimulation of donors in granulocyte transfusion programs [2]
On the basis of current evidence, we advocate the use of a combined single-dose regimen of G-CSF (300–600 μg subcutaneously) plus a corticosteroid (e.g., dexamethasone, 8 mg orally) administered to healthy adult donors 12 h before leukapheresis for optimal granulocyte yields [2, 6–8 ]. In a recent phase I/II trial of granulocyte transfusion therapy for the treatment of infections in patients after hematopoietic stem cell transplantation, the single-dose regimen of G-CSF/dexamethasone for granulocyte mobilization was not associated with any severe or prolonged adverse events in normal community donors [6]. Nonetheless, we agree and wish to emphasize that the long-term safety of the practice of treating normal donors with G-CSF is an important concern for the development of community donor-based granulocyte transfusion therapy programs [9–11 ]
