Severe neutropenia in children after renal transplantation: incidence, course, and treatment with granulocyte colony-stimulating factor

Abstract

Decreasing immunosuppressive or antimicrobial medications carries the risk of acute rejection or infection. Off-label treatment with G-CSF may present a safe and effective alternative.

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.…”

“…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.…”

Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

“…Leukopaenia was a very common finding in this study and its development was significantly associated with the higher MMF dose. Previous studies have reported leukopaenia rates of 18-36% by 12 months with differences between studies likely to relate to factors such as the use of concomitant medications such as trimethoprim/sulphamethoxazole and antiviral prophylaxis [8][9][10][19][20][21]27,28 . The peak onset of leukopaenia was at 3 months post-transplant, coinciding with protocolised prednisolone reduction and hence a reduced drive to neutrophil margination.…”