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Clinical toxicity and laboratory effects of granulocyte‐colony‐ stimulating factor (filgrastim) mobilization and blood stem cell apheresis from normal donors, and analysis of charges for the procedures
Author(s) -
Anderlini P.,
Przepiorka D.,
Seong D.,
Miller P.,
Sundberg J.,
Lichtiger B.,
Norfleet F.,
Chan K.W,
Champlin R.,
Korbling M.
Publication year - 1996
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1996.36796323057.x
Subject(s) - filgrastim , apheresis , medicine , granulocyte colony stimulating factor , plateletpheresis , surgery , adverse effect , hematopoietic stem cell transplantation , bone marrow , anesthesia , transplantation , platelet , chemotherapy
BACKGROUND: Apheresis of granulocyte‐colony‐stimulating factor (filgrastim)‐mobilized blood stem cells from normal donors is now being used in place of a marrow harvest in transplantation. How the adverse effects of and charges for this procedure compare with those of the standard marrow harvest is not known. STUDY DESIGN AND METHODS: Forty consecutive normal subjects who received filgrastim 96 micrograms/kg) subcutaneously twice daily for 4 to 6 days in preparation for apheresis were monitored prospectively by clinical and laboratory evaluation. RESULTS: Sixty‐two percent of the subjects required oral analgesics. None discontinued filgrastim prematurely. Bone pain (82%), headache (70%), fatigue (20%), and nausea (10%) were reported. Filgrastim caused a mean eightfold increase in neutrophil counts, a mean twofold increase in lymphocyte counts, a mean twofold rise in alkaline phosphatase and lactate dehydrogenase levels, and minor changes in serum potassium, magnesium, and uric acid. Adverse events and laboratory effects resolved within 7 days after apheresis. No apheresis stem cell donor required transfusion or hospitalization, and only one required an additional clinic visit after completion of apheresis. By comparison, a retrospective analysis of 33 normal marrow donors demonstrated that all received transfusion(s), 3 were hospitalized, 3 required additional clinic visits after the marrow harvest. The median total charges related to the two procedures were comparable (p = 0.43), although the charges were significantly lower for donors requiring only one apheresis procedure (p = 0.002). CONCLUSION: Filgrastim mobilization and apheresis of blood stem cells constitute a safe, well‐tolerated, and comparable or less expensive alternative to the traditional marrow harvest.