Yamamoto Keita, Doki Noriko, Senoo Yasushi, Najima Yuho, Kobayashi Takeshi, Kakihana Kazuhiko, Haraguchi Kyoko, Okuyama Yoshiki, Sakamaki Hisashi, Ohashi Kazuteru
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Division of Transfusion and Cell Therapy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Transfus Med Hemother. 2016 Nov;43(6):433-435. doi: 10.1159/000446814. Epub 2016 Oct 18.
Granulocyte-colony stimulating factor (G-CSF) is widely used to mobilize peripheral blood stem cells (PBSCs) in healthy donors. A few reports have shown that some healthy donors developed acute respiratory distress syndrome or capillary leak syndrome after more than several rounds of G-CSF administration or leukapheresis.
We report the case of a healthy donor for allogeneic stem cell transplantation who developed severe hypoxemia 1 h after only the first administration of G-CSF. The donor was administered 10 μg/kg G-CSF (lenograstim) subcutaneously for PBSC mobilization. 1 h after the first administration of G-CSF, the donor suddenly presented with dry cough and dyspnea. The oxygen saturation by pulse oximetry (SpO) in the room air was 88%. An electrocardiogram and chest radiography revealed no abnormalities. We excluded other causes of severe hypoxemia and diagnosed the donor with hypoxemia due to G-CSF administration, which was subsequently terminated. The donor was administered 2 l/min oxygen via a nasal cannula and 100 mg hydrocortisone intravenously. He subsequently recovered, and SpO in the room air returned to 98% 10 h after hypoxemia.
These respiratory symptoms might be related to anaphylactoid or hypersensitivity reaction. The donors should be observed for at least 1 h after the first administration of G-CSF.
粒细胞集落刺激因子（G-CSF）被广泛用于动员健康供者的外周血干细胞（PBSC）。有少数报告显示，一些健康供者在接受多轮G-CSF给药或白细胞分离术后出现了急性呼吸窘迫综合征或毛细血管渗漏综合征。
我们报告了1例异基因干细胞移植健康供者的病例，该供者在首次给予G-CSF仅1小时后就出现了严重低氧血症。该供者皮下注射10μg/kg G-CSF（来格司亭）以动员PBSC。首次给予G-CSF 1小时后，供者突然出现干咳和呼吸困难。室内空气中经脉搏血氧饱和度仪（SpO）测得的血氧饱和度为88%。心电图和胸部X线检查未见异常。我们排除了严重低氧血症的其他原因，并诊断该供者为因G-CSF给药导致的低氧血症，随后终止了给药。通过鼻导管给供者吸氧，流速为2l/min，并静脉注射100mg氢化可的松。他随后康复，低氧血症发生10小时后，室内空气中的SpO恢复到98%。
这些呼吸道症状可能与类过敏或过敏反应有关。首次给予G-CSF后，应对供者进行至少1小时的观察。
