[A risk of pulmonary edema associated with G-CSF pretreatment]

We reported a case of severe pulmonary edema in the normal adult after bone marrow harvesting (BMH), who had received granular cell stimulating factor (G-CSF) pretreatment. The patient was 38 year old healthy man who was a donor to his son suffering from SCID (severe complicated immunodefficiency). He was administered total of G-CSF 750 mcg for three days before BMH. At the end of the BMH procedure, the patient was becoming dyspneic followed by severe pulmonary edema that continued about 8 hours. The levels of TNF alpha and IL-6 in his plasma and endotracheal exudate were abnormally as high as 10 and 130 pg.ml-1 of TNF alpha in plasma and exudate respectively and as 51.8 pg.ml-1 of IL-6 in plasma. We speculate that G-CSF activates white cells and induces leaking of cytokines from white cells, and the severity of pulmonary edema is associated with the cytokines.