Bone marrow response to multiple filgrastim stimulations in patients with non hematological disorders

Background & Aim Introduction Filgrastim is used to mobilize CD34+ cells to peripheral blood (PB) or to enhance bone marrow (BM) collection for autologous and allogeneic hematopoietic cell transplantation (HCT) in hematological disorders. Filgrastim has also been used to improve bone marrow collection of total nucleated cells (TNC), which were then administered intrathecally (IT) to treat neurological diseases. The impact in the BM functioning in non-hematological patients, after multiple stimulations with filgrastim, is unknown. Purpose To establish the BM capacity of response after multiple stimulation procedures with filgrastim in children with neurological disorders. Methods, Results & Conclusion Methods Retrospective analysis of 13 patients with no BM diseases who underwent more than one cellular therapy (CT) since 2013, in our center. In each CT, patients received 10μg/kg/day of subcutaneous filgrastim for three days. Bone marrow collection was done on the fourth. The patients’ count of peripheral blood WBC before and after stimulation was analyzed, as well as the number of TNC, mononuclear cells (MNC), CD34+, and CD133+ cells per microliter contained in the collected BM. Every patient had received 3 or more CT procedures with at least 6 months in between each procedure. Wilcoxon's test was used to compare the count of CD34+ cells of the first CT against the subsequent CT. The standard p≤0.05 boundary was defined as a statistically significant value. Results From the thirteen patients included, 4 patients (31%) had undergone four CT, and the rest (69%) only three CT. The medians of the absolute MNC obtained from bone marrow showed minimal variations between the different collections (14.4, 18.06, 15.3, 13.8 k /µL, but the Wilcoxon's test did not show any statistically significant differences between the count of CD34+ and MNC cells in each CT. (Table 1) Conclusions BM performance in children without BM diseases, was effective in each stimulation. No significant differences in several cell counts can be observed between multiple CT. It does not seem that the use of filgrastim affects BM functioning after multiple stimulations.