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.
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.


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).


CONCLUSIONS
Filgrastim mobilization and apheresis of blood stem cells constitute a safe, well-tolerated, and comparable or less expensive alternative to the traditional marrow harvest.
Anderlini
P
P
Section of Blood Transplantation, University of Texas, M.D. Anderson Cancer Center, Houston, USA.
Przepiorka
D
D
Seong
D
D
Miller
P
P
Sundberg
J
J
Lichtiger
B
B
Norfleet
F
F
Chan
K W
KW
Champlin
R
R
Körbling
M
M
D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000700:Analgesics / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D016026:Bone Marrow Transplantation / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000494:pharmacology; D006261:Headache / Q000139:chemically induced; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007937:Leukapheresis / Q000009:adverse effects* / Q000191:economics; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010146:Pain / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology; D012189:Retrospective Studies; D012449:Safety; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics / Q000379:methods; D014527:Uric Acid / Q000097:blood
D000700:Analgesics; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D014527:Uric Acid; D007770:L-Lactate Dehydrogenase; D000469:Alkaline Phosphatase; D000069585:Filgrastim