Successful haematopoietic progenitor cell collection by plerixafor in combination with reduced dose granulocyte colony‐stimulating factor for severe hypoxemia provoked by high‐dose granulocyte colony‐stimulating factor administration

Granulocyte colony-stimulating factor (G-CSF) is widely utilised to mobilise haematopoietic progenitor cell (HPC) from the bone marrow into the blood for collecting HPCs, which is called HPC collection, for either autologous or allogeneic haematopoietic stem cell transplantation (HSCT). Adverse events associated with G-CSF administration include fever, bone pain, headache, fatigue, and myalgias. Albeit rarely, critical respiratory complications, such as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), have been reported with G-CSF administration. 1,2 We report a case of diffuse large B-cell lymphoma (DLBCL) with severe hypoxemia after high-dose G-CSF administration, followed by reduced dose G-CSF and plerixafor administration, which allowed us to collect a sufficient number of HPCs without complications. A 38-year-old man with recurrent DLBCL was admitted to our hospital for HPC collection. We attempted to mobilise HPCs with high-dose G-CSF administration during the haematopoietic recovery after the second course of R-IDEA (rituximab, ifosfamide, dexamethasone, etoposide, and cytarabine) chemotherapy. On Day 6 of R-IDEA, G-CSF (filgrastim, 200 μ g m (cid:1) 2 , single dose per day) administration was initiated. On Day 8, the patient developed high fever, diarrhoea, and hypotension. The levels of C-reactive protein (CRP) and procalcitonin were elevated to 23.94 mg dl (cid:1) 1 and 8.840 ng ml (cid:1) 1 , respectively. No significant bacteria or fungi