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培非格司亭用于健康供者外周血造血干细胞采集后发生的主动脉炎。

Aortitis after administration of pegfilgrastim to a healthy donor for peripheral blood stem cell collection.

机构信息

Department of Hematology and Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan.

Department of Immunology and Parasitology, St. Marianna University School of Medicine, Kawasaki, Japan.

出版信息

Int J Hematol. 2023 Dec;118(6):772-775. doi: 10.1007/s12185-023-03649-0. Epub 2023 Aug 14.

Abstract

A 45-year-old man who was a sibling donor for allogeneic peripheral blood stem cell transplantation (allo-PBSCT) was administered 7.2 mg of pegfilgrastim for stem cell collection. Peripheral blood stem cells were collected 4 days after administration of pegfilgrastim (Day 4) and 4.32 × 10 /kg of CD34-positive cells per recipient body weight were obtained. Fever of 38 ℃ or higher and left submandibular pain appeared on Day 6. Ultrasonography and contrast-enhanced computed tomography (CT) showed wall thickening of the carotid artery and the abdominal aorta. We carefully excluded the possibilities of cardiovascular and autoimmune diseases by thorough examination, and ultimately diagnosed pegfilgrastim-induced aortitis. The patient's fever resolved rapidly after treatment with prednisolone (PSL) 1 mg/kg. We began to taper PSL after eight days. Sixty-one days after starting PSL, we confirmed that abdominal aortic wall thickening had improved by contrast-enhanced CT. We continued to taper off PSL and stopped 141 days later with no relapse thereafter. This is the first case report of pegfilgrastim-induced aortitis in an allo-PBSCT donor. Careful monitoring is warranted when administering pegfilgrastim to donors even without past medical history.

摘要

一位 45 岁的男性,作为异基因外周血造血干细胞移植(allo-PBSCT)的供者,接受了 7.2mg 的培非格司亭进行干细胞采集。外周血造血干细胞在培非格司亭给药后第 4 天(第 4 天)采集,每位受者体重获得 4.32×10 /kg 的 CD34阳性细胞。第 6 天出现 38℃或更高的发热和左下颌疼痛。超声检查和对比增强 CT(CT)显示颈动脉和腹主动脉壁增厚。我们通过彻底检查仔细排除了心血管和自身免疫性疾病的可能性,并最终诊断为培非格司亭引起的大动脉炎。患者接受泼尼松龙(PSL)1mg/kg 治疗后,发热迅速消退。我们在八天后开始逐渐减少 PSL 的剂量。在开始 PSL 后 61 天,通过对比增强 CT 证实腹主动脉壁增厚得到改善。我们继续逐渐减少 PSL 的剂量,并在 141 天后停药,此后未再复发。这是首例 allo-PBSCT 供者中培非格司亭引起的大动脉炎病例报告。即使没有既往病史,在给予供者培非格司亭时也需要进行仔细监测。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9a14/10673976/b42c2731e9ac/12185_2023_3649_Fig1_HTML.jpg

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