Granulocyte colony-stimulating factor (G-CSF) administration in individuals with sickle cell disease: time for a moratorium?
Granulocyte colony-stimulating factor (G-CSF) administration in individuals with sickle cell disease: time for a moratorium?
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DOI：
10.1080/14653240902849788
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发表时间：
2009-01-01
期刊：
影响因子：
4.5
通讯作者：
Tisdale, John F.
中科院分区：
文献类型：
--
作者：
Fitzhugh, Courtney D.;Hsieh, Matthew M.;Tisdale, John F.
粒细胞集落刺激因子（G-CSF）通常用于减少接受化疗的患者的中性粒细胞减少症和住院时间，并获得用于移植应用的造血干细胞（HSC）。尽管G-CSF给药在大多数个体（包括镰状细胞性状受试者）中具有相对安全性，但在镰状细胞病（SCD）个体（包括给药前无症状和未确诊的患者）中使用时，已报告了严重和危及生命的并发症。目前已报告在总共11名SCD患者中给予G-CSF。7例发生严重不良事件，包括血管闭塞发作、急性胸部综合征、多器官系统衰竭和死亡。已采取预防措施，包括最大限度地减少峰值白色血细胞计数，分割或减少G-CSF剂量和红细胞输注以降低镰状血红蛋白（HbS）水平，但没有一致的获益。这些报告的数据表明，在SCD患者中给予G-CSF仅应在没有替代品的情况下并在充分披露所涉及的风险后进行。除非进一步的数据证明安全性，否则应避免在SCD患者中常规使用G-CSF。
Granulocyte colony-stimulating factor (G-CSF) is used commonly in an attempt to reduce the duration of neutropenia and hospitalization in patients undergoing chemotherapy and to obtain hematopoietic stem cells (HSC) for transplantation applications. Despite the relative safety of administration of G-CSF in most individuals, including subjects with sickle cell trait, severe and life-threatening complications have been reported when used in individuals with sickle cell disease (SCD), including those who were asymptomatic and undiagnosed prior to administration. The administration of G-CSF has now been reported in a total of 11 individuals with SCD. Seven developed severe adverse events, including vaso-occlusive episodes, acute chest syndrome, multiorgan system failure and death. Precautions, including minimizing the peak white blood cell count, dividing or reducing the G-CSF dose and red blood cell transfusions to reduce sickle hemoglobin (HbS) levels, have been employed with no consistent benefit. These reported data indicate that administration of G-CSF in individuals with SCD should be undertaken only in the absence of alternatives and after full disclosure of the risks involved. Unless further data demonstrate safety, routine usage of G-CSF in individuals with SCD should be avoided.