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Administration of G–CSF plus dexamethasone producesgreater granulocyte concentrate yields while causing nomore donor toxicity than G–CSF alone
Author(s) -
Stroncek David F.,
Yau Yu Ying,
Oblitas Jaime,
Leitman Susan F.
Publication year - 2001
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.1537-2995.2001.41081037.x
Subject(s) - dexamethasone , medicine , placebo , granulocyte colony stimulating factor , granulocyte , apheresis , platelet , chemotherapy , pathology , alternative medicine
BACKGROUND: G–CSF with or without dexamethasone is becoming the standard agent for mobilizing granulocytes for transfusion. The purpose of this study was to determine if the toxicities of G–CSF with or without dexamethasone are offset by greater collection yields and to define the minimum interval that should separate sequential collections. STUDY DESIGN AND METHODS: Twenty donors were studied on three occasions. They were given either dexamethasone (8 mg, by mouth) plus a placebo injection, G–CSF (5 μg/kg, given subcutaneously) plus placebo capsules, or G–CSF plus dexamethasone. Granulocytes were collected by apheresis. A donor symptom survey was administered, and cell counts and blood chemistries were assessed before collection and 1, 2, 7, 14, 21, 28, and 35 days after collection. RESULTS: More granulocytes were collected when G–CSF was given than when dexamethasone was given (41.1 ± 20.4 × 10 9 vs. 21.0 ± 10.0 × 10 9 ; p<0.001), but the use of G–CSF plus dexamethasone produced the greatest yields (67.1 ± 22.0 × 10 9 ; p<0.002). When the donors were given dexamethasone alone, 58 percent experienced at least one symptom, compared to 85 percent of those given G–CSF and 75 percent of those given G–CSF plus dexamethasone. In all three regimens, platelet counts fell 19 percent to 24 percent after collection and remained below baseline for 7 to 14 days. Granulocyte counts returned to baseline within 3 to 7 days, but, in all three regimens, a mild granulocytopenia occurred 21 days after collection. With each of the regimens, blood chemistries changed, but the changes were mild and most returned to baseline within 7 days; however, changes in albumin, bilirubin, and AST persisted until 28 days after collection. CONCLUSION: These results support the use of G–CSF plus dexamethasone in granulocyte donors. G–CSF plus dexamethasone resulted in greater granulocyte yields than either agent alone and was associated with donor symptoms and changes in blood cell counts and chemistries similar to those seen with G–CSF alone or dexamethasone alone. Granulocytes can be safely collected a second time after a 7‐day interval; however, for regular donors, it may be best to separate collections by 4 weeks.