Systemic Hypersensitivity to G-CSF in a Healthy Donor Followed By Successful Drug Challenge Allowing Stem Cell Donation
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Ki Lee Milligan, MD, Enkhtsetseg Purev, MD, Richard Childs, MD, Joshua D. Milner, MD
Rationale: Suspected anaphylaxis after first dose of G-CSF in healthy donors has been reported 3 times. Prior cases had shortness of breath, tachycardia and hypotension within 40-90 minutes.  All cases received epinephrine and no further G-CSF doses.  We describe a woman with systemic G-CSF hypersensitivity who underwent successful drug challenge and donated stem cells.

Methods: Graded challenge with G-CSF

Results: A healthy 43-year-old Ecuadorian female volunteered for sibling stem cell donation. She had incidental eosinophilia (620-1000 eosinophils/uL) and IgE of 144 IU/ml. Twenty minutes after her subcutaneous G-CSF injection, she reported throat tightness, dyspnea and wheezing, diaphoresis, nausea, dimming vision and headache. Heart rate was 130, and blood pressure 110/80. She remained alert, though anxious and received oxygen, albuterol nebulizer and diphenhydramine (25 mg orally). Symptoms resolved within 10 minutes except for residual headache. Several features of her reaction were inconsistent with IgE mediated anaphylaxis. She had a first dose reaction (without presumed allergic sensitization), normal blood pressure, lack of skin and mucosal findings, and rapid recovery without epinephrine. She received a graded dose challenge with 10% of her 960 ug dose (10ug/kg), followed 30 minutes later by 90% of her dose. She remained well for 1 hour, and completed the remaining G-CSF course without incident concluding in stem cell harvest.

Conclusions: We believe this is the first reported case of G-CSF drug challenge in a healthy donor. Distinguishing anaphylaxis from non-IgE mediated systemic reactions after G-CSF may allow selected donors the option for drug challenge to explore safety of continued therapy with G-CSF.