Evaluation of Filgrastim Therapy in Kidney Transplant Recipients

Abstract

The use of filgrastim in kidney transplant recipients demonstrated success in reversing neutropenia. Short courses of therapy were required with minimal adverse events. Patients who required readmission were successfully re-treated. Additional studies are required to determine the most effective dose and duration of treatment.

Single‐center, real‐world experience with granulocyte colony‐stimulating factor for management of leukopenia following kidney transplantation

“…Although G-CSF dosing in our study was variable, the average G-CSF dose administered was similar to the dose recommended in the oncology population (5 mcg/kg/day) 22 and administered in other trials of kidney transplant patients with leukopenia. 6,9,15,16 Following administration of mean 2.1 ± 1.9 doses of G-CSF, we observed WBC count recovery in median 9 (IQR 4-14) days, which is longer than previously reported in the literature. 5,6,15,16 Rather than a lack of efficacy in our cohort, this discrepancy likely reflects the reduced laboratory monitoring frequency for our patients managed in the outpatient setting.…”

“…6,9,15,16 Following administration of mean 2.1 ± 1.9 doses of G-CSF, we observed WBC count recovery in median 9 (IQR 4-14) days, which is longer than previously reported in the literature. 5,6,15,16 Rather than a lack of efficacy in our cohort, this discrepancy likely reflects the reduced laboratory monitoring frequency for our patients managed in the outpatient setting. Furthermore, we defined study inclusion based on leukopenia (WBC < 3000 cells/μL), 1,3,6,16 but all patients with available ANC data were neutropenic (ANC < 1000 cells/μL) at the time of G-CSF initiation.…”

“…6,9,15,16 Following administration of mean 2.1 ± 1.9 doses of G-CSF, we observed WBC count recovery in median 9 (IQR 4-14) days, which is longer than previously reported in the literature. 6,9,15,16 Following administration of mean 2.1 ± 1.9 doses of G-CSF, we observed WBC count recovery in median 9 (IQR 4-14) days, which is longer than previously reported in the literature.…”

“…5,6,15,16 Rather than a lack of efficacy in our cohort, this discrepancy likely reflects the reduced laboratory monitoring frequency for our patients managed in the outpatient setting. Furthermore, we defined study inclusion based on leukopenia (WBC < 3000 cells/μL), 1,3,6,16 but all patients with available ANC data were neutropenic (ANC < 1000 cells/μL) at the time of G-CSF initiation. Therefore, an ANC cut-off of <1000 cells/ μL may provide a more optimal trigger for G-CSF initiation than the WBC count alone.…”

“…Data in kidney transplant recipients are limited, but existing literature suggests a decrease in the duration of leukopenia following G-CSF use, with many patients achieving WBC count recovery after only 1-3 doses. 1,2,5,9,[13][14][15][16] In patients with leukopenia secondary to CMV infection, G-CSF may also prevent the need for ganciclovir or VGCV dose reduction during treatment, which has been associated with development of ganciclovir-resistant CMV. 6,[17][18][19] Through retrospective review, we sought to describe overall management of leukopenia including dosing and efficacy of G-CSF in kidney transplant recipients in both the inpatient and outpatient setting at our institution.…”