Lenograstim With Or Without Dexamethasone for Neutrophil Mobilization in Healthy Donors: Short-Term Kinetics of White Blood Cells and Effects of Granulocyte Apheresis

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Abstract

Objectives:

To determine the optimal time schedule for neutrophil collection after single mobilization with glycosylated recombinant granulocyte colony-stimulating factor (G-CSF, lenograstim) with or without dexamethasone (DXM). Donors and Methods: In this prospective randomized trial, 26 healthy volunteers were randomly assigned to a single subcutaneous dose of lenograstim 6 μg/kg plus 8-mg DXM (G-CSF/DXM, n = 13) or placebo (G-CSF/placebo, n = 13). Hematological and biochemical parameters were analyzed before and 12, 15, 18, 21, 24, 27, 29, 36, 48, 60, 72, and 84 h and 7 and 30 days after mobilization. Six G-CSF/DXM subjects underwent standard neutrophil apheresis (NA) 12 and 36 h after mobilization. Results: Polymorphonuclear neutrophil (PMN) counts 12 and 21 h after mobilization were 22.7 (16.6−32.8) × 109/L and 22.4 (18.6−30.6) × 109/L for G-CSF/placebo versus 33.1 (24.2–44.9) × 109/L and 32.5 (17.4–39.6) × 109/L for G-CSF/DXM. This mobilization plateau was followed by slow normalization at 72–84 h. The six NA subjects had median PMN yields of 62 (47–101) × 109 and 39 (23–42) × 109 per therapeutic unit. After the first apheresis, PMN counts sharply decreased to 21.1 (14.8–26.3) × 109/L and then temporarily recovered to 25.9 (18.9–36.5) × 109/L (P ≤ 0.001) over the next 8 h. Conclusions: Single doses of lenograstim with or without DXM induced a PMN plateau that lasted 9 h (12–21 h after mobilization), with PMN counts suitable for neutrophil collection. Lenograstim plus DXM made it possible to perform NA twice, 12 and 36 h after mobilization.

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