Affect of Cardiac Complications After Allogeneic Hematopoietic Stem Cell Transplantation From Various Stem Cell Sources
Biology of Blood and Marrow Transplantation
To evaluate the incidences of adverse events of granulocyte colony-stimulating factor (G-CSF) and the impacts of post G-CSF white blood cell (WBC) counts on adverse events and mobilization yields in healthy peripheral blood stem cell donors. Materials and Methods: Four hundred seventy-six healthy donors were given G-CSF of 10mg/kg/day for 5-6 consecutive days. The WBC counts were determinated at baseline, after third dose (before the forth dose on Day4) and after fifth dose (before
... before leukapheresis on Day5) of G-CSF administration. Performance status and symptoms were recorded everyday before G-CSF injection. The incidences of adverse events and mobilization yields were compared between different donor characteristic groups. Multivariate analysis was used to analyze the correlations between the adverse events and donor factors. Results: Bone pain (64.9%), myalgia/arthralgia (58.2%), fatigue (44.1%) and headache (33.0%) were the most common side effects. The third day and fifth day median WBC counts were 35,050/mL and 45,905/mL. Donors with WBC $ 50x10 3 /mL after 3 doses of G-CSF experienced more fatigue, myalgia/arthralgia and chills (p 5 0.0314, 0.0066 and 0.0121) but post G-CSF CD34 + cells were similar (72.6/mL vs 68.7/mL, p 5 0.5916). Although the CD34 + cells were higher in donors with WBC $ 50x10 3 /mL after 5 doses of G-CSF (89.3/mL vs 59.1/mL, p \ 0.0001), the incidences of side effects were similar. Female donors more frequently had headache, nausea/ anorexia, vomiting, fever (p 5 0.003, \ 0.0001, 0.0016 and 0.0392) and lower post G-CSF CD34 + cell count than male donors did (78.0/mL vs 59.0/mL, p \ 0.0001). Donors with body mass index $ 25 had higher incidences of sweat and insomnia (p 5 0.0211 and 0.0318) and also higher CD34 + cell count (79.9/mL vs 64.9/mL, p \ 0.0001). Donor receiving G-CSF $ 10mg/kg tended to have bone pain, headache and chills (p 5 0.0085, 0.0270 and 0.0085). The side effects and CD34 + cells were not different between young and old donors. In multivariate analysis, female donor experienced more fatigue, nausea, vomiting, bone pain, myalgia/arthragia, headache, fever and insomnia. Higher BMI donor had more fatigue, myalgia/arthragia and sweats. G-CSF dose was associated with bone pain and the WBC count post the third G-CSF was associated with fatigue only. Conclusion: Female and high BMI donors are associated with higher risk of side effects of PBSC mobilization by G-CSF. Routine monitor of the post G-CSF WBC count provide minimal benefit in predicting side effects. Reducing dose or discontinuation of G-CSF should mainly base on the clinical severity of adverse events.