Life-threatening capillary leak syndrome after G-CSF mobilization and collection of peripheral blood progenitor cells for allogeneic transplantation

We report a case of capillary leak syndrome in a 37-year-old female PBPC do nor who received G-CSF 900 mug/day for 4 days and underwent leukapheresis. This lady had remained well and stable despite marked leukocytosis during G -CSF treatment, but developed hypotension during leukapheresis, quickly fol lowed by hypoxemia, ascites, pericardial and pleural effusion, shock, edema , neurologic changes and hepatocellular injury. Upon G-CSF withdrawal, dopa mine and crystalloid infusion, methylprednisolone treatment and suspension of apheresis, the clinical situation fully reversed. We hypothesize that le ukapheresis, in the presence of marked leukocytosis and high doses of GCSF, may have triggered neutrophil activation and the release of inflammatory m ediators, resulting in tissue damage and systemic manifestations of increas ed capillary permeability.