The incidence of bone pain with granulocyte colony stimulating factor (G-CSF) administration and the effect of hydroxyzine

Abstract

8242 Background: The bone pain frequently emerges as one of the side effects of G-CSF administration. Rising pressure within bone marrow by increased granulocytes, edema within bone marrow by histamine release, and increased level of bradykinin are thought to be the mechanisms underlying it. The incidence of bone pain is reported to be 1–5% of all cases, but in practice we have the impression that there have been more cases with bone pain, some of which are resistant to treatment with non-steroid anti-inflammatory drugs (NSAIDs). So we reexamined the incidence of bone pain with G-CSF and the analgesic effect of hydroxyzine. Methods: 1) We sent out questionnaires about the presence of bone pain and its details to patients who are administered G-CSF in the past and analyzed those answers, retrospectively. 2) Prospectively since 2003, we administered NSAIDs or hydroxyzine (50mg b.i.d.) to patients with bone pain after G-CSF administration and examined its analgesic effect. With next G-CSF administration in those patients, we administered hydroxyzine beforehand, and checked its preventive effect. Results: 1) The incidence of bone pain with G-CSF administration was 10% (2 cases in 20 patients) by questionnaires, retrospectively. 2) Prospectively, 40 patients were administrated G-CSF by neutropenia since 2003. In 4 cases with bone pain after G-CSF administration, NSAIDs were ineffective, but hydroxyzine was effective in such cases. The preventive administration of hydroxyzine suppressed the pain. Conclusions: The incidence of bone pain with G-CSF may be higher clinically than reported before. Hydroxyzine is effective to the bone pain, and it also protects against the onset of the bone pain. No significant financial relationships to disclose.