Purpose: Granulocyte colony-stimulating factors (G-CSF), such as filgrastim, stimulate the production, proliferation, and differentiation of neutrophils and are indicated for the treatment of neutropenia in bone marrow transplantation recipients, patients receiving chemotherapy, and those with chronic neutropenia or acute myeloid leukemia. There have not been sufficient studies of using G-CSF in renal transplant recipients to establish a clear role for filgrastim that is safe and effective in this patient population. The purpose of this study was to evaluate the use of filgrastim in kidney transplant recipients presenting with neutropenia.

Methods: A retrospective chart review was performed in which patients were selected based on a medication utilization report of filgrastim in kidney transplant recipients at our center from September 2012 to August 2015. Baseline characteristics were studied, as well as the date, dose, and duration of filgrastim; success of treatment; and any consequences of therapy. Treatment success was defined as the reversal of neutropenia (white blood cell count of at least 3 x 10^9 cells/L) within seven days of discharge from the hospital.

Results: There were 28 cases of neutropenia among 21 patients during the time period studied. Patients were treated with a range of one to five doses of filgrastim 300 mcg or 480 mcg, with a mean of 1.79 doses. The mean total dose of filgrastim administered per episode of neutropenia was 632 mcg (8.6 mcg/kg) with a range of 300 mcg to 1860 mcg. Neutropenia was successfully reversed after a mean of three days. Overall, 87.5 percent among these 28 cases achieved a white blood cell count of at least 3 x 10^9 cells/L within seven days of discharge from the hospital. There were seven cases that required readmission. Myalgia and fatigue were reported in one patient. There were no cases of infection or acute rejection following treatment with filgrastim.

Conclusions: The use of filgrastim in kidney transplant recipients demonstrated success in the reversal of neutropenia to prevent infection without increasing the risk of rejection. These patients required short courses of filgrastim therapy and experienced minimal adverse events. Patients that required readmission for neutropenia were successfully treated with additional doses. Additional studies are required to determine the most effective dose and duration of treatment.

CITATION INFORMATION: Poon T, Guerra C. Evaluation of the Utilization of Filgrastim in Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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