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Liu L, Zhang DS, Zhang XJ, Zheng ZZ, Wang SB. A case of acute lung injury in a peripheral blood stem cell donor mobilized with pegylated recombinant human granulocyte colony-stimulating factor. Int J Hematol 2024:10.1007/s12185-024-03779-z. [PMID: 38730189 DOI: 10.1007/s12185-024-03779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) has been introduced for the mobilization of peripheral blood stem cells (PBSCs). However, no cases of acute lung injury (ALI) in healthy donors have been reported, and the underlying mechanisms remain poorly understood. We first reported a case of ALI caused by PEG-rhG-CSF in a healthy Chinese donor, characterized by hemoptysis, hypoxemia, and patchy shadows. Ultimately, hormone administration, planned PBSC collection, leukocyte debridement, and planned PBSC collection resulted in active control of the donor's ALI. The donor's symptoms improved without any adverse effects, and the PBSC collection proceeded without incident. Over time, the lung lesion was gradually absorbed and eventually returned to normal. PEG-rhG-CSF may contribute to ALI in healthy donors via mechanisms involving neutrophil aggregation, adhesion, and the release of inflammatory mediators in the lung. This case report examines the clinical manifestations, treatment, and mechanism of lung injury induced by PEG-rhG-CSF-mobilized PBSCs.
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Affiliation(s)
- Lin Liu
- Department of Hematology, The 920 Hospital of PLA Joint Logistics Support Force, No. 212, Daguan Road, Xishan District, Kunming, 650032, Yunnan Province, China
| | - Ding-Song Zhang
- Department of Hematology, The 920 Hospital of PLA Joint Logistics Support Force, No. 212, Daguan Road, Xishan District, Kunming, 650032, Yunnan Province, China
| | - Xue-Juan Zhang
- Department of Hematology, The 920 Hospital of PLA Joint Logistics Support Force, No. 212, Daguan Road, Xishan District, Kunming, 650032, Yunnan Province, China
| | - Zhong-Zheng Zheng
- Shanghai Tissuebank Biotechnology Co., Ltd, No. 908. Ziping Road, #21 Building, Pudong New District, Shanghai, 201318, China.
| | - San-Bin Wang
- Department of Hematology, The 920 Hospital of PLA Joint Logistics Support Force, No. 212, Daguan Road, Xishan District, Kunming, 650032, Yunnan Province, China.
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Noel JG, Ramser SW, Pitstick L, Goetzman HS, Dale EL, Potter A, Adam M, Potter SS, Gardner JC. IL-1/MyD88-Dependent G-CSF and IL-6 Secretion Mediates Postburn Anemia. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 210:972-980. [PMID: 36779805 PMCID: PMC10038902 DOI: 10.4049/jimmunol.2200785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
The anemia of critical illness (ACI) is a nearly universal pathophysiological consequence of burn injury and a primary reason burn patients require massive quantities of transfused blood. Inflammatory processes are expected to drive postburn ACI and prevent meaningful erythropoietic stimulation through iron or erythropoietin supplementation, but to this day no specific inflammatory pathways have been identified as a critical mechanism. In this study, we examined whether secretion of G-CSF and IL-6 mediates distinct features of postburn ACI and interrogated inflammatory mechanisms that could be responsible for their secretion. Our analysis of mouse and human skin samples identified the burn wound as a primary source of G-CSF and IL-6 secretion. We show that G-CSF and IL-6 are secreted independently through an IL-1/MyD88-dependent mechanism, and we ruled out TLR2 and TLR4 as critical receptors. Our results indicate that IL-1/MyD88-dependent G-CSF secretion plays a key role in impairing medullary erythropoiesis and IL-6 secretion plays a key role in limiting the access of erythroid cells to iron. Importantly, we found that IL-1α/β neutralizing Abs broadly attenuated features of postburn ACI that could be attributed to G-CSF or IL-6 secretion and rescued deficits of circulating RBC counts, hemoglobin, and hematocrit caused by burn injury. We conclude that wound-based IL-1/MyD88 signaling mediates postburn ACI through induction of G-CSF and IL-6 secretion.
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Affiliation(s)
- John G Noel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth W Ramser
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lori Pitstick
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Holly S Goetzman
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elizabeth L Dale
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Potter
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mike Adam
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - S Steven Potter
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jason C Gardner
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
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Chen LN, Montemayor-Garcia C, West-Mitchell KA, Cantilena CC. Increased serum pro-B-type natriuretic peptide in hematopoietic progenitor cell donors stimulated with G-CSF. J Clin Apher 2022; 37:354-359. [PMID: 35301751 PMCID: PMC9378357 DOI: 10.1002/jca.21979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/07/2022]
Abstract
Hematopoietic stem cells (HPCs) donors mobilized by granulocyte-colony-stimulating factor (G-CSF) can develop various signs and symptoms. proBNP (pro-B-type natriuretic peptide) is a serum marker of heart failure. A donor who developed severe adverse reactions after G-CSF mobilization was found to have high serum proBNP levels. We followed additional donors who received identical mobilization regimen to investigate the prevalence of this phenomenon. Eighteen healthy donors underwent a mobilization regimen of 10 μg/Kg G-CSF daily for 5 days prior to allogeneic HPC collection using Spectra Optia between January 2016 and February 2017 were included in this study. Serum proBNP levels were measured before and after G-CSF stimulation and immediately after apheresis. Apheresis collection parameters and other laboratory results were also reviewed. The majority of donors (86.7%) had post-G-CSF elevation of serum proBNP. Seven of those had elevated proBNP above upper normal range (124 pg/ml). The subgroup of donors with normal proBNP is younger (median age of 37 vs 42 years), with majority being male (90.9% vs 28.6%) and with smaller processed blood volume (2.2 vs 3 × total blood volume). This case series demonstrates an increase of serum proBNP can be common in HPC donors stimulated with 5 days of 10 mcg/kg G-CSF. This is an adverse reaction that has not been described before. The temporary elevation of proBNP in these donors is not associated with ventricular dysfunction of the heart. The risk factors for marked elevation of proBNP post-G-CSF should be further investigated.
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Affiliation(s)
- Leonard N Chen
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Cathy C Cantilena
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Hematopoiesis, Inflammation and Aging-The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals. J Clin Med 2022; 11:jcm11030706. [PMID: 35160156 PMCID: PMC8836692 DOI: 10.3390/jcm11030706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/27/2023] Open
Abstract
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences.
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Bruserud Ø, Aarstad HH, Tvedt THA. Combined C-Reactive Protein and Novel Inflammatory Parameters as a Predictor in Cancer-What Can We Learn from the Hematological Experience? Cancers (Basel) 2020; 12:cancers12071966. [PMID: 32707721 PMCID: PMC7409204 DOI: 10.3390/cancers12071966] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
The acute phase reaction is a systemic response to acute or chronic inflammation. The serum level of C-reactive protein (CRP) is the only acute phase biomarker widely used in routine clinical practice, including its uses for prognostics and therapy monitoring in cancer patients. Although Interleukin 6 (IL6) is a main trigger of the acute phase reactions, a series of acute phase reactants can contribute (e.g., other members in IL6 family or IL1 subfamily, and tumor necrosis factor α). However, the experience from patients receiving intensive chemotherapy for hematological malignancies has shown that, besides CRP, other biomarkers (e.g., cytokines, soluble cytokine receptors, soluble adhesion molecules) also have altered systemic levels as a part of the acute phase reaction in these immunocompromised patients. Furthermore, CRP and white blood cell counts can serve as a dual prognostic predictor in solid tumors and hematological malignancies. Recent studies also suggest that biomarker profiles as well as alternative inflammatory mediators should be further developed to optimize the predictive utility in cancer patients. Finally, the experience from allogeneic stem cell transplantation suggests that selected acute phase reactants together with specific markers of organ damages are useful for predicting or diagnosing graft versus host disease. Acute phase proteins may also be useful to identify patients (at risk of) developing severe immune-mediated toxicity after anticancer immunotherapy. To conclude, future studies of acute phase predictors in human malignancies should not only investigate the conventional inflammatory mediators (e.g., CRP, white blood cell counts) but also combinations of novel inflammatory parameters with specific markers of organ damages.
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Affiliation(s)
- Øystein Bruserud
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
- Section for Hematology, Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
- Correspondence: ; Tel.: +47-5597-2997
| | - Helene Hersvik Aarstad
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
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Aarstad HH, Guðbrandsdottir G, Hjelle KM, Bostad L, Bruserud Ø, Tvedt THA, Beisland C. The Biological Context of C-Reactive Protein as a Prognostic Marker in Renal Cell Carcinoma: Studies on the Acute Phase Cytokine Profile. Cancers (Basel) 2020; 12:cancers12071961. [PMID: 32707675 PMCID: PMC7409073 DOI: 10.3390/cancers12071961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022] Open
Abstract
High serum levels of the acute phase protein C-reactive protein (CRP) are associated with an adverse prognosis in renal cancer. The acute phase reaction is cytokine-driven and includes a wide range of inflammatory mediators. This overall profile of the response depends on the inducing event and can also differ between patients. We investigated an extended acute phase cytokine profile for 97 renal cancer patients. Initial studies showed that the serum CRP levels had an expected prognostic association together with tumor size, stage, nuclear grading, and Leibovich score. Interleukin (IL)6 family cytokines, IL1 subfamily mediators, and tumor necrosis factor (TNF)α can all be drivers of the acute phase response. Initial studies suggested that serum IL33Rα (the soluble IL33 receptor α chain) levels were also associated with prognosis, although the impact of IL33Rα is dependent on the overall cytokine profile, including seven IL6 family members (IL6, IL6Rα, gp130, IL27, IL31, CNTF, and OSM), two IL1 subfamily members (IL1RA and IL33Rα), and TNFα. We identified a patient subset characterized by particularly high levels of IL6, IL33Rα, and TNFα alongside an adverse prognosis. Thus, the acute phase cytokine reaction differs between renal cancer patients, and differences in the acute phase cytokine profile are associated with prognosis.
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Affiliation(s)
- Helene Hersvik Aarstad
- Department of Clinical Science, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway;
| | - Gigja Guðbrandsdottir
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway; (G.G.); (K.M.H.); (C.B.)
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway
| | - Karin M. Hjelle
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway; (G.G.); (K.M.H.); (C.B.)
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway
| | - Leif Bostad
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Øystein Bruserud
- Department of Clinical Science, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway;
- Department of Medicine, Section for Hematology, Haukeland University Hospital, N-5021 Bergen, Norway;
- Correspondence: ; Tel.: +47-5597-2997
| | - Tor Henrik Anderson Tvedt
- Department of Medicine, Section for Hematology, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway; (G.G.); (K.M.H.); (C.B.)
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway
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Li B, Lu J, Peng DZ, Zhang XY, You Z. Elevated platelet distribution width predicts poor prognosis in hilar cholangiocarcinoma. Medicine (Baltimore) 2020; 99:e19400. [PMID: 32195935 PMCID: PMC7220385 DOI: 10.1097/md.0000000000019400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although the platelet distribution width (PDW) has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge the prognostic value of PDW in hilar cholangiocarcinoma (HC) has not been studied. The aim of the study was to investigate the prognostic value of PDW in HC patients. A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection with at least a 5-year follow-up. The optimal cutoff value of PDW was determined by receiver operating characteristic (ROC) curve. Survival analysis by the Kaplan-Meier method and the difference between the clinico-pathologic variables and survival was evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS). ROC curve analysis suggested that the optimal cutoff value for the PDW was 16.55. There were significant associations of high PDW with high white blood cell (P < .001) and high neutril-to-lymph ratio (P < .001). In a multivariate analysis, the PDW was an independent prognostic factor for overall survival (HR = 2.521, 95% CI 1.832-3.470, P < .001). In conclusions, our findings indicate that PDW may have clinical significance in predicting OS after surgery in HC patients.
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Affiliation(s)
- Bei Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang
- West China-Washington Mitochondria Metabolism Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jiong Lu
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang
| | - Ding-Zhong Peng
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang
| | - Xin-Yi Zhang
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang
| | - Zhen You
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang
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Abstract
RATIONALE Granulocyte colony-stimulating factor (G-CSF) is most frequently used in healthy donors to mobilize progenitor cells into the peripheral blood for collection. While mild thrombocytopenia is common in allogeneic peripheral blood stem cell transplant donors after G-CSF mobilization, serious thrombocytopenia is rarely reported. Herein, we report a case of severe thrombocytopenia caused by G-CSF in a 14-year-old healthy donor and review the relevant literature. To our knowledge, this is the first reported case of severe thrombocytopenia caused by G-CSF in a healthy adolescent donor. PATIENT CONCERNS A 14-year-old sister of a girl with T lymphocyte leukemia was selected as a matched donor for transplantation. The donor was healthy with normal blood parameters. DIAGNOSES The donor received 10 μg/kg/day G-CSF via subcutaneous injection. On day 4 of G-CSF administration, blood tests before stem cell collection indicated that platelets dropped to 51 g/L. Abdominal ultrasound showed that the spleen was mildly enlarged. INTERVENTIONS In order to prevent blood loss and other effects caused by a too low platelet count after collection, the donor's peripheral blood hematopoietic stem cells were collected after platelet transfusion. OUTCOMES Checkups for 1 year after G-CSF administration showed normal blood parameters. LESSONS Due to the rare risk of severe thrombocytopenia in G-CSF mobilization, it is necessary to routinely monitor blood parameters during mobilization to ensure smooth progress of the transplantation process.
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Affiliation(s)
| | - Yu Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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