Splenic Rupture in a Parental Donor Undergoing Peripheral Blood Progenitor Cell Mobilization

Abstract

Peripheral blood progenitor cells (PBPCs) are now widely used as a source of progenitor cells for allogeneic transplantation. Recombinant human granulocyte colony-stimulating factor is used to mobilize PBPCs for collection by leukapheresis. Although side effects of mobilization are generally benign, adverse effects have been reported. The authors present a case of spontaneous splenic rupture, without splenomegaly, in a parental donor undergoing PBPC mobilization, review the literature regarding this adverse event, and explore issues regarding donor safety.

Splenic rupture in a patient with plasma cell myeloma following G-CSF/GM-CSF administration for stem cell transplantation and review of the literature

“…16 The splenomegaly has been attributed to infiltration of the red pulp by granulocytes in some cases as well as the presence of extramedullary hematopoiesis in others. Although splenomegaly seems to be a common side effect, there are only occasional cases of splenic rupture reported and we have attempted to identify all cases of splenic rupture related to G-CSF/GM-CSF therapy reported in the English literature (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13] with an additional case from our institution. Recently, a similar study was published by Nuamah et al, 12 but it does not include all published cases.…”

“…As noted in Table 1, there is a broad range of underlying disorders with most being hematologic. [2][3][4][5][6][7][8][9][10][11][12][13] The splenic rupture occurred not only in patients with underlying hematopoietic disorders, but also in patients with solid tumors and healthy donors. Most patients experienced malaise, pain radiating to the left shoulder, drop in blood pressure and decrease in hematocrit.…”

“…The salient features of all cases with splenic rupture involving G-CSF/GM-CSF treatment that have been reported in the English literature are summarized in Table 1. [2][3][4][5][6][7][8][9][10][11][12][13] The cases include individuals receiving G-CSF/GM-CSF for neutropenia, patients being prepared for autologous stem cell transplant and donors undergoing PBPC mobilization. Of note is the fact that spontaneous splenic ruptures occurred not only in diseased patients, but also in healthy donors.…”

Evaluation of Hematopoietic Stem Cell Donors

“…Spontaneous splenic rupture is reported in 3 normal peripheral blood HSC donors. [18][19][20] In 2 cases the spleen was surgically removed and disclosed extensive extramedullary hematopoiesis. Platzbecker et al performed ultrasound evaluations of spleen size before and after G-CSF mobilization in 91 healthy donors.…”

Intracranial hemorrhage caused by cerebrovascular malformation after donation of rhG-CSF-primed allogeneic PBSC

“…2 Spontaneous splenic rupture was reported in three normal hematopoietic PBSC donors. 3 Cerebral arteriovenous malformations (AVMs) are congenital anomalies that consist of abnormal arteries and veins without an intervening capillary bed. A large autopsy series has shown the incidence of AVMs to be between 0.04 and 0.52%.…”