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Uemura Y, Oshima K, Fuseya A, Hosokai A, Ohashi A, Kanno M, Arai A. Aortitis after administration of pegfilgrastim to a healthy donor for peripheral blood stem cell collection. Int J Hematol 2023; 118:772-775. [PMID: 37578593 PMCID: PMC10673976 DOI: 10.1007/s12185-023-03649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
A 45-year-old man who was a sibling donor for allogeneic peripheral blood stem cell transplantation (allo-PBSCT) was administered 7.2 mg of pegfilgrastim for stem cell collection. Peripheral blood stem cells were collected 4 days after administration of pegfilgrastim (Day 4) and 4.32 × 106 /kg of CD34-positive cells per recipient body weight were obtained. Fever of 38 ℃ or higher and left submandibular pain appeared on Day 6. Ultrasonography and contrast-enhanced computed tomography (CT) showed wall thickening of the carotid artery and the abdominal aorta. We carefully excluded the possibilities of cardiovascular and autoimmune diseases by thorough examination, and ultimately diagnosed pegfilgrastim-induced aortitis. The patient's fever resolved rapidly after treatment with prednisolone (PSL) 1 mg/kg. We began to taper PSL after eight days. Sixty-one days after starting PSL, we confirmed that abdominal aortic wall thickening had improved by contrast-enhanced CT. We continued to taper off PSL and stopped 141 days later with no relapse thereafter. This is the first case report of pegfilgrastim-induced aortitis in an allo-PBSCT donor. Careful monitoring is warranted when administering pegfilgrastim to donors even without past medical history.
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Affiliation(s)
- Yu Uemura
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Kumi Oshima
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Aika Fuseya
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Akane Hosokai
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Ayaka Ohashi
- Department of Immunology and Parasitology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masatoshi Kanno
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Ayako Arai
- Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan.
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IgA nephropathy diagnosed as a result of acute exacerbation due to G-CSF administration. CEN Case Rep 2022:10.1007/s13730-022-00764-5. [PMID: 36508113 PMCID: PMC10393928 DOI: 10.1007/s13730-022-00764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) is commonly used to stimulate bone marrow production. G-CSF is usually safe but sometimes causes serious adverse effects and, in rare cases, exacerbates glomerulonephritis. We report a case of immunoglobulin A (IgA) nephropathy that was aggravated by G-CSF. A 56-year-old Japanese man with no relevant medical history was admitted to our hospital as a donor of peripheral blood stem cells (PBSCs) for transplantation. To mobilize PBSCs, he received subcutaneous G-CSF (lenograstim), 500 μg for 4 days. Three days after the first dose of lenograstim, gross hematuria appeared, and after administration on the fourth day, renal dysfunction and nephrotic-range proteinuria were observed. Renal biopsy and light microscopic study revealed mild mesangial proliferation with expansion in association with the presence of cellular segmental crescents. Immunofluorescence study revealed diffuse, granular staining in the mesangium for IgA, complement component 3 (C3), and lambda light chains. We diagnosed highly active IgA nephropathy and initiated treatment with prednisolone and azathioprine. Three months later, renal function returned to normal. Screening for hidden chronic glomerulonephritis should be performed when G-CSF is administered, as in PBSC donors. Immunosuppressant therapy, such as prednisolone or azathioprine, is considered for exacerbations of highly active glomerulonephritis.
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Angel Korman A, Leiba A, Edel Y, Rapoport V, Tobar A, Leiba M. G-CSF-induced ANCA associated glomerulonephritis in the presence of silent membranous "full house nephropathy" in an altruistic bone marrow donor. Ren Fail 2022; 44:1498-1500. [PMID: 36000895 PMCID: PMC9415626 DOI: 10.1080/0886022x.2022.2115380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Avital Angel Korman
- Nephrology and Hypertension Institute, Samson Assuta University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Leiba
- Nephrology and Hypertension Institute, Samson Assuta University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yonatan Edel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Department of Internal Medicine 'B', Assuta Ashdod University Hospital, Ashdod, Israel
| | - Vladimir Rapoport
- Nephrology and Hypertension Institute, Samson Assuta University Hospital, Ashdod, Israel
| | - Ana Tobar
- Department of Pathology, Beilinson Medical Center, Petah Tikva, Israel
| | - Merav Leiba
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Hematology Institute, Samson Assuta University Hospital, Ashdod, Israel
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Ito S, Uchida T, Oshima N, Oda T, Kumagai H. Development of membranoproliferative glomerulonephritis-like glomerulopathy in a patient with neutrophilia resulting from endogenous granulocyte-colony stimulating factor overproduction: a case report. BMC Nephrol 2018; 19:251. [PMID: 30286731 PMCID: PMC6172840 DOI: 10.1186/s12882-018-1049-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 09/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background The pathophysiologic role of exogenous granulocyte-colony stimulating factor (G-CSF) administration is reportedly linked to the progression of glomerulonephritis. However, the relationship between endogenous G-CSF overproduction and the progression of glomerulopathy has not been well investigated. Case presentation A 76-year-old woman presented with neutrophilia at a medical check-up and thorough examination revealed a high level of serum G-CSF. She subsequently developed mild renal dysfunction and proteinuria. Her renal biopsy showed lobulation of the glomeruli with mesangial proliferation and glomerular capillary walls with a double contour but no immune complex deposition, suggesting membranoproliferative glomerulonephritis-like glomerulopathy. Thereafter, her proteinuria levels fluctuated in parallel with the changes in her blood neutrophil count and finally reduced considerably in association with her decreased neutrophil count. Conclusions The unique features of this case suggest that endogenous overproduction of G-CSF could play an important role in the pathogenesis of active glomerulonephritis.
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Affiliation(s)
- Seigo Ito
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Takahiro Uchida
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Naoki Oshima
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takashi Oda
- Department of Nephrology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroo Kumagai
- Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Moalic-Allain V. Medical and ethical considerations on hematopoietic stem cells mobilization for healthy donors. Transfus Clin Biol 2018; 25:136-143. [PMID: 29555414 DOI: 10.1016/j.tracli.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
Hematopoietic stem cell transplantation is a common procedure potentially beneficial to many individuals with cancer, hematological, or inherited disorders, and has highlighted the need of related or unrelated donors to perform allograft. Donation of hematopoietic stem cells, either through bone marrow harvest or peripheral blood stem cell collection, is well-established and widespread. Over the past two decades, the peripheral blood stem cell collection by aphaeresis has become the main source of hematopoietic stem cells for transplantation, due to faster engraftment and practicability and lower risk of relapse for high-risk patients. For peripheral blood stem cell donation, donors require mobilization of hematopoietic stem cells from bone marrow into the blood stream. This is performed by growth factors injections. This article is a review of reported applications of growth factors (original granulocyte colony stimulating factor and its biosimilars), for healthy donors' peripheral blood stem cell mobilization, in terms of toxicity, side effects, efficacy and follow-up. There is still an ethical dilemma for clinicians involved in allograft, because they expose healthy donors to drugs. It is important to dispel some of the critical concerns regarding their use in healthy volunteers, particularly because they receive no personal therapeutic benefit from this procedure.
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Affiliation(s)
- V Moalic-Allain
- Laboratoire de génétique moléculaire et d'histocompatibilité, pôle de pathologie biologie, CHRU Morvan, bâtiment 5 bis, RDC, 2, avenue Foch, 29609 Brest cedex, France.
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Batal I, Markowitz GS, Wong W, Avasare R, Mapara MY, Appel GB, D'Agati VD. Filgrastim-Induced Crescentic Transformation of Recurrent IgG2λ GN. J Am Soc Nephrol 2016; 27:1911-5. [PMID: 27147425 DOI: 10.1681/asn.2016010061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Proliferative GN with monoclonal IgG deposits is an increasingly recognized form of GN, but its relation to hematologic malignancy remains poorly understood. Filgrastim, an analog for granulocyte colony-stimulating factor produced by recombinant DNA technology, is frequently used to stimulate bone marrow release of hematopoietic progenitor cells in preparation for stem cell transplant. We report an exceptional case of proliferative GN with monoclonal IgG2λ deposits in a young man whose disease progressed slowly to CKD, which was followed by a preemptive kidney transplant. The patient developed recurrent GN in the allograft and clinically detectable plasma cell neoplasm 9 years after the first renal manifestations. Contemporaneous with filgrastim administration for stem cell mobilization, the patient's slowly progressive GN underwent severe crescentic transformation, leading to rapidly progressive and irreversible allograft failure. This report explores the spectrum of GN with monoclonal IgG deposits and the pathophysiologic role of granulocyte colony-stimulating factor in exacerbation of preexisting GN.
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Affiliation(s)
- Ibrahim Batal
- Renal Pathology, Department of Pathology and Cell Biology,
| | | | | | | | - Markus Y Mapara
- Division of Hematology/Oncology and Columbia Center for Translational Immunology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Exacerbation of IgA nephropathy following G-CSF administration for PBSC collection: suggestions for better donor screening. Bone Marrow Transplant 2015; 51:286-7. [PMID: 26437069 DOI: 10.1038/bmt.2015.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Matsuguma K, Matsuki S, Sakamoto K, Shiramoto M, Nakagawa M, Kimura M, Irie S, Kaneko D, Ohnishi A. A comparative pharmacokinetic and pharmacodynamic study of FSK0808 versus reference filgrastim after repeated subcutaneous administration in healthy Japanese men. Clin Pharmacol Drug Dev 2015; 4:99-104. [DOI: 10.1002/cpdd.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/12/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Kyoko Matsuguma
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Shunji Matsuki
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Kei Sakamoto
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Masanari Shiramoto
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Misato Nakagawa
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Miyuki Kimura
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Shin Irie
- From the LTA Medical Corporation Kyushu Clinical Pharmacology Research Clinic; 2-13-16; Jigyo Chuo-ku Fukuoka 810-0064 Japan
| | - Daiki Kaneko
- Fuji Pharma Co., Ltd.; 5-7 Sanban-cho Chiyoda-ku Tokyo 102-0075 Japan
| | - Akihiro Ohnishi
- Department of Laboratory Medicine; The Jikei University School of Medicine; 4-11-1 Izumihoncho Komae Tokyo 201-8601 Japan
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Deferrals of volunteer stem cell donors referred for evaluation for matched-unrelated stem cell donation. Bone Marrow Transplant 2014; 49:1419-25. [DOI: 10.1038/bmt.2014.171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 01/12/2023]
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Lower risk for serious adverse events and no increased risk for cancer after PBSC vs BM donation. Blood 2014; 123:3655-63. [PMID: 24735965 DOI: 10.1182/blood-2013-12-542464] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared serious early and late events experienced by 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors who underwent collection of PBSC or BM between 2004 and 2009 as part of a prospective study through the National Marrow Donor Program. Standardized FDA definitions for serious adverse events (SAEs) were used, and all events were reviewed by an independent physician panel. BM donors had an increased risk for SAEs (2.38% for BM vs 0.56% for PBSC; odds ratio [OR], 4.13; P < .001), and women were twice as likely to experience an SAE (OR for men, 0.50; P = .005). Restricting the analysis to life-threatening, unexpected, or chronic/disabling events, BM donors maintained an increased risk for SAEs (0.99% for BM vs 0.31% for PBSC; OR, 3.20; P < .001). Notably, the incidence of cancer, autoimmune illness, and thrombosis after donation was similar in BM vs PBSC donors. In addition, cancer incidence in PBSC donors was less than that reported in the general population (Surveillance, Epidemiology, and End Results Program database). In conclusion, SAEs after donation are rare but more often occurred in BM donors and women. In addition, there was no evidence of increased risk for cancer, autoimmune illness, and stroke in donors receiving granulocyte colony-stimulating factor during this period of observation.
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Moalic V. Mobilization and collection of peripheral blood stem cells in healthy donors: Risks, adverse events and follow-up. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.patbio.2012.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Arora S, Bhargava A, Jasnosz K, Clark B. Relapsing acute kidney injury associated with pegfilgrastim. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2013; 2:165-71. [PMID: 23326257 PMCID: PMC3542938 DOI: 10.1159/000345278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We report a previously unrecognized complication of severe acute kidney injury (AKI) after the administration of pegfilgrastim with biopsy findings of mesangioproliferative glomerulonephritis (GN) and tubular necrosis. A 51-year-old white female with a history of breast cancer presented to the hospital with nausea, vomiting and dark urine 2 weeks after her third cycle of cyclophosphamide and docetaxel along with pegfilgrastim. She was found to have AKI with a serum creatinine (Cr) level of 6.9 mg/dl (baseline 0.7). At that time, her AKI was believed to be related to prior sepsis and/or daptomycin exposure that had occurred 5 weeks earlier. She was dialyzed for 6 weeks, after which her kidney function recovered to near baseline, but her urinalysis (UA) still showed 3.5 g protein/day and dysmorphic hematuria. Repeat blood cultures and serological workup (complement levels, hepatitis panel, ANA, ANCA and anti-GBM) were negative. She received her next cycle of chemotherapy with the same drugs. Two weeks later, she developed recurrent AKI with a Cr level of 6.7 mg/dl. A kidney biopsy showed mesangioproliferative GN, along with tubular epithelial damage and a rare electron-dense glomerular deposit. Pegfilgrastim was suspected as the inciting agent after exclusion of other causes. Her Cr improved to 1.4 mg/dl over the next 3 weeks, this time without dialysis. She had the next 2 cycles of chemotherapy without pegfilgrastim, with no further episodes of AKI. A literature review revealed a few cases of a possible association of filgrastim with mild self-limited acute GN. In conclusion, pegfilgrastim may cause GN with severe AKI. Milder cases may be missed and therefore routine monitoring of renal function and UA is important.
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Affiliation(s)
- Swati Arora
- Division of Nephrology and Hypertension, Department of Medicine, Temple University School of Medicine, Pittsburgh, Pa., USA
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