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Intracranial hemorrhage caused by cerebrovascular malformation after donation of rhG-CSF-primed allogeneic PBSC

Bone Marrow Transplantation volume 42, pages 61–62 (2008)Cite this article

PBSC are now widely used as a source of progenitor cells for allogeneic transplantation. Recombinant human G-CSF (rhG-CSF) is used to mobilize PBSC for collection by leukapheresis. Although side effects of mobilization are generally benign, adverse effects have been reported. We present a case of intracranial hemorrhage caused by cerebrovascular malformation in a sibling donor undergoing PBSC mobilization.

The number of allogeneic transplantations of rhG-CSF-mobilized PBSC is increasing. Although PBSC donation is a reasonably safe procedure, adverse events do occur. The symptoms reported in most PBSC donors are related to hematopoietic growth factors, usually rhG-CSF. According to the survey results from 1080 PBSC donors reported by National Marrow Donor Program,1 bone pain was the most common cytokine-associated symptom. Headache was also common. Pain was usually manageable with non-narcotic analgesics. Other symptoms such as nausea, vomiting, myalgia, fatigue, insomnia and injection site reactions were often observed. The apheresis procedure was also a source of adverse events. Anticoagulation with acid-citrate-dextrose solution may elicit symptoms of hypocalcemia—perioral numbness, paresthesias and carpopedal spasms—requiring oral or i.v. calcium supplementation. Important hematologic changes were also expected to occur with growth factors and the apheresis procedure. WBC, in particular neutrophils, increased dramatically. At daily filgrastim doses of 10 μg/kg or greater, the total WBC count may reach 70–80 × 109/l. Although clinically significant, leukostasis was not reported and it was generally recommended that the filgrastim dose can be reduced if the count exceeds 70–75 × 109/l. Concomitant with leukocytosis, platelet counts decline although usually the reduction is modest. Thrombocytopenia was the most significant finding post-apheresis. The platelets did not begin to recover until 3–4 days after the last collection. Some serious complications had been reported, but serious hemorrhage secondary to thrombocytopenia had not been reported. Filgrastim administration may precipitate severe sickle crisis in persons with sickle cell anemia or complex sickle cell hemoglobinopathies.2 Spontaneous splenic rupture was reported in three normal hematopoietic PBSC donors.3

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References

  1. Horowitz MM, Confer DL . Evaluation of hematopoietic stem cell donors. Hematology Am Soc Hematol Educ Program 2005, 469–475.

    Article  Google Scholar 

  2. Wei A, Grigg A . Granulocyte colony-stimulating factor induced sickle cell crisis and multi-organ dysfunction in a patient with compound heterozygous sickle cell/B+ thalassemia. Blood 2001; 97: 3998–3999.

    Article  CAS  Google Scholar 

  3. Dincer AP, Gottschall J, Margolis DA . Splenic rupture in a parental donor undergoing peripheral blood progenitor cell mobilization. J Pediatr Hematol Oncol 2004; 26: 761–763.

    Article  Google Scholar 

  4. Pollock BE, Flickinger JC, Lunsford LD, Bissonnette DJ, Kondziolka D . Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke 1996; 27: 1–6.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are very grateful to Yongkang Xu, Guohai Xie (Department of Neurosurgery), Dong Cen, (Department Medical Laboratory), Guoping Zhong (Department of Pathology) and Yinzhou People's Hospital for their assistance.

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  1. Department of Hematology, Yinzhou People's Hospital, Ningbo, China. E-mail: peirz@163.com,

    R Z Pei, J X Ma, P S Zhang, X H Liu, J J Cao & X H Du

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Pei, R., Ma, J., Zhang, P. et al. Intracranial hemorrhage caused by cerebrovascular malformation after donation of rhG-CSF-primed allogeneic PBSC. Bone Marrow Transplant 42, 61–62 (2008). https://doi.org/10.1038/bmt.2008.77

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