Published: 6 March 2025

Publications

Sickle-cell crisis with pegfilgrastim and filgrastim

Published: 6 March 2025
Prescriber Update 46(1): 10–11
March 2025

A case of sickle cell crisis in a patient taking pegfilgrastim was reported to the New Zealand Pharmacovigilance database. To date, this is the first report received for sickle cell crisis reported with any medicine in New Zealand.

Sickle cell disease

Sickle cell disease (SCD) refers to a group of inherited red blood cell (RBC) disorders. Genetic mutations change the haemoglobin structure, which causes abnormal, crescent-shaped (sickle) red blood cells and leads to vaso-occlusive crisis, anaemia and organ damage. SCD is a multisystem disease associated with episodes of acute illness and progressive organ damage.^1,2

There are several genotypes associated with SCD, the most common genotype is homozygous haemoglobin SS (HbSS) which causes sickle cell anaemia. The prevalence of SCD is high among the people of sub-Saharan Africa, South Asia, the Middle East, and the Mediterranean.²

Sickle cell crisis

Patients with SCD can experience episodes of acute pain commonly referred to as sickle cell pain crises (SCC) or vaso-occlusive crises (VOCs). SCC/VOCs are the primary presenting cause of hospitalisation and morbidity associated with SCD.³

Most episodes of SCC do not have an identifiable cause. Some triggers include hypoxia, infections, fever, dehydration, exposure to cold/weather changes and stress.^2,3 These triggers cause haemoglobin polymerisation (the process by which haemoglobin molecules stick together to form fibres) resulting in rigid, sickle-shaped red blood cells. The blood cells do not easily flow through the circulation and cause small vessel occlusion, pain, local hypoxia and inflammation.²

Pain can occur in any region but frequently affects the extremities, back and chest areas.² Clinical consequences of SCC/VOCs include acute chest syndrome, hepatic and renal injury, cerebrovascular accident (stroke) and multiorgan failure resulting in death.³

Pegfilgrastim and filgrastim and SCC

SCC (in some cases fatal) has been reported in patients with SCD treated with pegfilgrastim/filgrastim.^4,5

Leukocytosis (high leukocyte count) has been observed in patients taking pegfilgrastim.^4,5 In patients with SCD, leukocytosis in the absence of infection is a predictor of poor clinical outcomes.⁶ Therefore, clinicians should exercise caution when administering pegfilgrastim/filgrastim to patients with SCD.^4,5

Refer to the appropriate guidelines and/or specialist advice for management of SCC in patients with SCD.

References

1. Rees DC, Williams TN and Gladwin MT. 2010. Sickle-cell disease. The Lancet 376(9757): 2018-31. DOI: https://doi.org/10.1016/S0140-6736(10)61029-X (accessed 15 January 2025).
2. Borhade MP, Patel P, Kondamudi NP. 2024. Sickle Cell Crisis. In: StatPearls 25 February 2024. URL: www.ncbi.nlm.nih.gov/books/NBK526064/ (accessed 15 January 2025).
3. Darbari DS, Sheehan VA and Ballas SK. 2020. The vaso-occlusive pain crisis in sickle cell disease: Definition, pathophysiology, and management. European Journal of Haematology 105(3): 237-46. DOI: https://doi.org/10.1111/ejh.13430 (accessed 14 January 2025).
4. Amgen New Zealand Limited. 2022. Neupogen New Zealand Data Sheet 30 November 2022. URL: www.medsafe.govt.nz/profs/datasheet/n/Neupogeninj.pdf (accessed 15 January 2025).
5. Sandoz New Zealand Limited. 2024. Ziextenzo New Zealand Data Sheet 26 November 2024. URL: www.medsafe.govt.nz/profs/datasheet/z/Ziextenzoinj.pdf (accessed 5 March 2025).
6. Maakaron JE. 2025. Sickle cell disease. In: Medscape – Drugs & Diseases: Hematology updated 23 January 2025. URL: emedicine.medscape.com/article/205926 (accessed 7 February 2025).