Safety of Pegfilgrastim (Neulasta) in Patients with Sickle Cell Trait/Anemia

Table 1

Summary of other similar cases of sickle cell crises reported in patients receiving colony stimulating factors [17]⁺.

Study	Year	𝑁	Sickle cell	Growth factor	Adverse event/complication	Outcome/comments
Pieters et al. [16]	1995	1	Sickle cell disease (SCD)	Intra-lesional G-CSF into a leg ulcer	Sickle cell pain crisis	Responded to supportive care
Abboud et al. [12]	1998	1	Sickle cell disease (SCD)	G-CSF*	Sickle cell pain crisis and possibly acute chest syndrome	Responded to supportive care and hydroxyurea
Adler et al. [14]	2001	1	Mild hemoglobin sickle cell	G-CSF	Sickle cell crisis, massive splenomegaly, and disseminated intravascular coagulation (DIC)	Death
Wei and Grigg [15]	2001	1	Compound heterozygous sickle cell/beta+; thalassemia	G-CSF	Sickle cell crisis leading to acute chest syndrome, DIC, and life threating multiorgan failure	Prolonged hospitalization for 8 weeks due to aforementioned complications
Kang et al. [11]	2002	8	8 SCT^x and 8 matched controls	G-CSF	No major adverse events reported; however, patients with SCT reported higher on the symptom score^#	Responded to supportive care and analgesics
Richard et al. [22]	2005	3	Sickle cell disease (SCD)	G-CSF	2 patients developed sickle cell pain crisis	1 of the patients required parenteral narcotics
Kambel et al. [19]	2006	1	Hemoglobin SC (HbSC) disease	G-CSF	Severe sickle cell pain crisis requiring hospitalization	Split dose schedule for G-CSF and exchange transfusion to lower HbS levels from 20% to 6% were done to help complete treatment for patient’s lymphoma
Rosenbaum et al. [18]	2008	5	4 with hemoglobin SS; (HbSS) and 1 with hemoglobin SC (HbSC) disease	G-CSF	3 out of 5 patients develop symptoms suggestive of vasoocclusive crisis (VOC)	Responded to supportive care; only 1 patient required a packed red blood cell transfusion
Tormey et al. [21]	2008	1	Sickle cell disease (SCD)	G-CSF	Exchange transfusions done prior to prevent VOC	No significant complications reported
Onitilo et al. [20]	2003	1	Sickle cell disease (SCD)	G-CSF	No significant complications noted	Was hypertransfused to a hematocrit of more than 40% to prevent sickle cell crises

 ⁺Five of the studies presented here are already summarized in a table by Fitzhugh et al. Article as open access. Permission also obtained from the author [17].
*G-CSF: granulocyte colony stimulating factor (there are no reports with the pegylated form of the drug).
^xSCT: sickle cell trait.
^#Most common symptoms reported included nausea, headaches, myalgias, and fatigue. The average use of analgesics was also higher (13 tablets versus 6.25 tablets in patients with SCT versus controls resp.).