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A dose‐response analysis of lenograstim plus dexamethasone for neutrophil mobilization and collection
Author(s) -
Heuft HansGert,
Goudeva Lilia,
Pulver Nicole,
Grigull Lorenz,
Schwella Nimrod,
Blasczyk Rainer
Publication year - 2005
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.0041-1132.2005.04240.x
Subject(s) - medicine , dexamethasone , granulocyte colony stimulating factor , absolute neutrophil count , apheresis , white blood cell , adverse effect , granulocyte , neutropenia , mobilization , gastroenterology , chemotherapy , platelet , archaeology , history
BACKGROUND: The objective was to evaluate the dose‐response relationship of lenograstim plus dexamethasone for neutrophil mobilization and collection. STUDY DESIGN AND METHODS: In a prospective study, 260 healthy volunteers received oral dexamethasone (8 mg) plus a single subcutaneous injection of glycosylated granulocyte–colony‐stimulating factor (G–CSF; lenograstim) at medians of 1.5 (1.0‐2.3) µg per kg (n = 43), 3 (2.4‐4.1) µg per kg (n = 73), 6 (4.3‐7.9) µg per kg (n = 123), and 12 (8.2‐17.2) µg per kg (n = 21) and underwent neutrophil collections with a polymorphonucleated neutrophil (PMN) program. White blood cell (WBC) counts and PMN mobilization and collection results were compared, and the severity and clinical significance of donor adverse reactions were evaluated. Fifty‐two neutropenic patients (29 children, 23 adults) underwent 271 neutrophil transfusions (GTXs) every other day to maintain WBC levels continuously above 0.5 × 10 9 per L. RESULTS: Within the dose range 1.5, 3, and 6 µg per kg, each doubling step was associated with a 10 to 15 percent PMN increase in peripheral blood up to 32.8 (19.1‐49.2) × 10 9 per L (6 µg/kg; p ≤ 0.00032) as well as in the neutrophil concentrate up to 79 (34‐150) × 10 9 per U (6 µg/kg; p ≤ 0.00042). A further doubling to 12 µg per kg achieved neither better mobilization nor better apheresis results. The rate of clinically important adverse reactions increased already with the 6 µg per kg mobilization step. The GTX resulted in median peak WBC increments to 3.8 (0.4‐18.2) × 10 9 per L (children) and 1.6 (0.3‐9.4) × 10 9 per L (adults), but in adults the WBC threshold of 0.5 × 10 9 per L was not continuously exceeded. CONCLUSIONS: The most effective dose‐response ratio for PMN mobilization was demonstrated in the 6 µg per kg lenograstim group. In neutropenic adults, GTX treatment on an every‐other‐day schedule may be ineffective.