Drug-induced liver injury due to granulocyte colony-stimulating factor in a healthy donor for allogeneic peripheral blood stem cell transplantation.

Background and objectives: Granulocyte-colony stimulating factor (G-CSF) is commonly used for peripheral blood stem cell harvesting (PBSCH). Although its well-documented adverse effects include thrombocytopaenia and bone pain, drug-induced liver injury (DILI) is rare.

Materials and methods: We present the case of a 40-year-old male donor who developed DILI 4 days after G-CSF administration for PBSCH.

Results: Laboratory results indicated elevated hepatobiliary enzymes, with aspartate aminotransferase (AST) peaking at 171 U/L (×6 the upper limit of normal [ULN]) on Day 7 of G-CSF administration, alanine aminotransferase (ALT) at 244 U/L (×6 ULN) on Day 11, alkaline phosphatase (ALP) at 371 U/L (×3 ULN) on Day 5 and gamma-glutamyl transpeptidase (γ-GTP) 93 U/L (×1.5 ULN) on Day 9. The hepatobiliary dysfunction became evident after G-CSF administration had ended, despite other parameters-including white blood cell and platelet counts-remaining within acceptable ranges. DILI was confirmed by positive drug lymphocyte stimulation test results. The donor's liver function normalized within 1 month of supportive treatment, and the recipient achieved successful engraftment without G-CSF administration.

Conclusion: As G-CSF allergy screening is not mandatory in current Japanese protocols, DILI due to G-CSF could present a risk during PBSCH. This case emphasizes the importance of vigilant monitoring and comprehensive risk assessment to ensure the safety of healthy donors.