Spleen enlargement following recombinant human granulocyte colony-stimulating factor administration for peripheral blood stem cell mobilization.
OBJECTIVE
Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is widely used to mobilize peripheral blood stem cells (PBSC) for autologous or allogeneic transplants. Such treatment may cause spleen enlargement; exceptionally, spontaneous spleen rupture has been reported. We investigated changes in spleen size during stem cell mobilization.


METHODS
We evaluated spleen size, comparing palpation with ultrasound (US)-evaluated longitudinal diameter and volume, in 13 healthy donors and 22 patients with a hematological malignancy who were undergoing PBSC mobilization with rhG-CSF-including regimens.


RESULTS
Intraobserver and interobserver variability of US-calculated spleen volume was very low; the correlation between the volume calculated by US and that measured by 3-dimensional computed tomography was excellent. During mobilization, spleen enlargement was detected by palpation in 17% of subjects, by US-measured longitudinal diameter in 60%, and by US-calculated volume in 91%. The median increase in spleen volume was 300 mL (range, 54-820; p<0.001) in healthy donors and 135 mL (range, 0-413; p=0.004) in the group of patients; the enlargement correlated with white blood cell count elevation (p=0.016) but not with circulating CD34+ cells. One month after the last administration of rhG-CSF, the median decrease was 160 mL (range, 35-800) in healthy donors and 58 mL (range, 0-310) in patients.


CONCLUSIONS
When evaluated by sensitive methods, rhG-CSF caused spleen enlargement in almost all individuals treated. US-calculated volume proved to be an excellent method, much better than longitudinal diameter, for detecting non-palpable splenomegaly induced by rhG-CSF.
Picardi
Marco
M
Division of Hematology, Federico II University Medical School, Naples, Italy.
De Rosa
Gennaro
G
Selleri
Carmine
C
Scarpato
Nicola
N
Soscia
Ernesto
E
Martinelli
Vincenzo
V
Ciancia
Rosanna
R
Rotoli
Bruno
B
D000293:Adolescent; D000328:Adult; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011994:Recombinant Proteins; D012016:Reference Values; D013163:Splenomegaly / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor