Hematopoietic stem cell transplantation is increasingly used to treat hematologic malignancies, hemoglobinopathies, solid tumors, and autoimmune diseases. Approximately 15,000 donors currently provide hematopoietic stem cells to allogeneic stem cell transplant patients each year. Peripheral blood hematopoietic stem cell (PBSC) transplantation is increasing each year, with data from the Center for International Peripheral Blood and Marrow Transplant Research (CIBMTR) showing that PBSC transplantation in North America accounted for 75% of related donors and 50% of unrelated donors in 2003. Although donating PBSC is fairly safe for most donors, some adverse reactions do occur and therefore a thorough evaluation of the donor should be performed before donating stem cells and it is necessary to be aware of the most common and serious potential adverse events. This article is a review of the various adverse reactions of donor PBSC to the donor. 1, donor PBSC common adverse reactions Most donor donor PBSC adverse reactions and the use of hematopoietic growth factors, bone pain is the most common symptom, probably related to granulocyte colony-stimulating factor (G-CSF) changes the metabolism of bone, increasing alkaline phosphatase and reducing serum calcitonin, this bone pain is diffuse, to the vertebrae, hip or pelvis and the rib cage is most obvious, when It disappears immediately after G-CSF is discontinued. Headache is also a common symptom and can be relieved by non-narcotic analgesics. Other symptoms include nausea, vomiting, myalgia, fatigue, insomnia, and discomfort at the puncture site. The stem cell collection procedure is also a source of adverse reactions, and anterior elbow venipuncture may cause local hematoma and microhemorrhage. The use of ACD anticoagulants can cause symptoms of hypocalcemia: perioral numbness, abnormal sensation, hand and foot cramps, requiring oral or intravenous calcium supplementation. Adverse effects ∞3 were specifically: myalgia 54%, headache 52%, malaise (depression) 49%, insomnia 28%, nausea 15%, sweating 14%, other flu-like symptoms 12%, loss of appetite 11%, fever 6%, chills 6%, vomiting 2%. 2. Hematological changes after PBSC donation The most important hematological change after G-CSF is the significant increase of white blood cells, especially neutrophils, and the total number of white blood cells will reach (70-80)×109/L with daily application of 10/g/kg or higher dose of G-CSF. Although clinical stagnation of white blood cells has not been reported, it is recommended that WBC>(70-75)×109/L When G-CSF dose is reduced the thrombocytopenia that accompanies leukocytosis is usually mild, and peripheral blood leukocytes are reduced after stem cell collection, with mild leukopenia, lymphocytopenia, and anemia occurring within a few weeks after collection. Thrombocytopenia is the most significant post-collection complication. Donor platelets decline by approximately 20%-30% after each standard circulating volume (12-20 L) of collection until 3-4 d after the last collection platelets gradually recover, although severe bleeding, moderate thrombocytopenia has not been reported, and aspirin, NSAIDs should be used with caution during mobilization and collection. tassi et al. performed a study of 94 cases mobilized with G-CSF PBSC donors followed up for 30 (4-84) months, 23/94 cases after mobilization with G-CSF showed significant thrombocytopenia below normal baseline levels, and the reduction in platelets correlated with total G-CSF dose, pre-collection platelet levels, and donor age. Platelet counts returned to normal levels 4-8 months after collection. 55/94 donors had neutropenia and lymphocytopenia, and the decrease in neutrophils and lymphocytes from baseline levels was 40% and 36%, respectively, 2 weeks after collection. long-term follow-up observations revealed that neutropenia and lymphocytopenia were self-limiting, and most donors returned to normal levels 2 years after PBSC collection. Cavallaro et al. showed that the erythrocyte pressure, leukocytes, platelets, neutrophils, lymphocytes, and monocytes were all in the normal range in 70 PBSC donors during a 3-year follow-up period, confirming that the hematological changes of G-CSF are short-term and reversible. 3, other rare adverse reactions The application of G-CSF may cause severe sickle cell anemia or heterogeneous sickle cell hemoglobinopathy donors to develop sickle cell crisis. A 47-year-old female patient with sickle cell anemia, previously asymptomatic, was reported to have developed severe sickle cell crisis during mobilization with G-CSF for her sister’s hematopoietic stem cell donation. Kang et al. safely mobilized and collected stem cells from 9 sickle cell anemia donors who had higher symptom scores than the other 8 donors at the same time, but did not develop sickle cell crisis. 3 normal PBSC donors had spontaneous splenic rupture. In two of these cases, extensive extramedullary hematopoiesis was found by surgical outpatient resection. 91 donors were evaluated by ultrasound for spleen size before and after G-CSF mobilization by Platzbecker et al. No adverse splenic events occurred in these donors, but the spleen increased in length and width. Significant blood biochemical changes have also been reported, including increases in uric acid, lactate dehydrogenase, and alkaline phosphatase.G-CSF may increase episodes of autoimmune disease, and episodes of rheumatoid arthritis and ankylosing spondylitis have been reported with fingostatin or saghostatin, and patients with thyroid antibodies present but normal thyroid function have developed abnormal thyroid function after treatment with saghostatin. Some ocular inflammatory reactions, including limbal keratitis, outer scleral inflammation, and iritis, have also been reported in PBSC donors applying filgrastim. Mary et al. reported a total of three cases of death in PBSC transplant donors so far, from sickle cell crisis, stroke, and cardiac arrest, respectively. due to the relatively little experience with allogeneic PBSC donation, the mortality rate is currently difficult to estimate with certainty. 4. long-term follow-up adverse reactions Cavallaro et al. followed 101 PBSC donors for up to 3-6 years, all of whom received a median of 16ug/kgd called G-CSF mobilization for 6(3-15) d. Most donors had mild short-term adverse reactions after mobilization with a median follow-up of 43.13(35-75) months. g-CSF Before mobilization 2 donors had tumors, l had myocardial infarction, l was HCV positive, 1 had a history of sinusitis, 1 had Graves’ disease, and 2 had hypertension. One donor with myocardial infarction developed transient angina pectoris after collection, one with Graves’ disease developed stroke, and the other donors did not have exacerbation of symptoms. 2 cases were pregnant after G-CSF mobilization, 1 was 3 weeks pregnant during mobilization, 2 of the 3 pregnant women produced normal infants, and 1 had spontaneous abortion more than 2 years after G-CSF mobilization. Two donors developed prostate cancer and breast cancer at 11 and 75 months of follow-up, respectively. Follow-up over 3 to 6 years confirmed that PBSC mobilization with G-CSF in normal healthy donors was safe and no significant adverse effects were observed. Only 1 donor had below normal blood picture at more than 3 years follow-up, 12 donors had decreased physical fitness, 9 of them had average physical fitness before donating stem cells, these 9 donors had chest pain at 2-70 months follow-up, the remaining donors included palpitations, lymph node enlargement, breast cancer, severe flu-like symptoms, Parkinson’s disease, prostate cancer, and elevated blood glucose. 1 pregnant woman had a cerebrovascular accident 15 months after the end of G-CSF. A cerebrovascular accident occurred 15 months after the end of G-CSF in a pregnant woman, which was associated with Moyamoya disease in the donor prior to G-CSF use. The use of high doses of G-CSF (16 Fg/kgd-1) has been reported to cause transient pre-thrombotic hypercoagulability in normal donors, so the use of G-CSF may affect the donor’s cardiac blood supply status. 5. Whether the use of G-CSF increases tumor incidence In vitro experiments have confirmed that G-CSF can stimulate normal hematopoietic progenitor cells, leukemic cells, and non-hematopoietic cells to add value and differentiate and mature. Leukemic cells as well as solid tumor cells have been found to express G-CSF receptors on their surface, so the use of G-CSF could theoretically promote tumorigenesis. However, there is no evidence that G-CSF increases the development of leukemia and other tumors in healthy donors. Heil et al. randomized 531 patients with acute myeloid leukemia and administered G-CSF during induction and consolidation chemotherapy, and there were no differences in remission rates or disease-free survival between the 2 groups, confirming that G-CSF does not promote leukemic cell growth. Conversely, some investigators have suggested that G-CSF may have an anti-leukemic effect. One study reported 3 patients with acute myeloid leukemia who were treated with G-CSF alone without other chemotherapeutic agents and achieved complete remission, and another reported the successful treatment of a relapsed leukemia patient with G-CSF. 6. Infants and children as stem cell donors Child donors are more likely to require allogeneic blood transfusion than adult donors, but serious complications are rare. Pulsipher et al. reported 201 donors with a median age of 11.8 months (8 months to 17 years) with 218 stem cell collections mobilized by G-CSF, of which the mean number of CD34+ cells collected was 9.1 X106/kg recipient body weight, G-CSF-related pain was mild and less than 15% of donors complained of pain. 92% (23/25) of donors less than 20 kg required erythrocyte prefilling of the collection machine tubing, and >200 collections demonstrated that PBSC collection was safe in normal pediatric subjects, with donors less than 20 kg requiring a single erythrocyte infusion. deLa Rubia et al. reported Kawano et al. concluded that G-CSF-associated pain was age-dependent in 19 pediatric donors, with none of the 9 pediatric donors younger than 10 years complaining of discomfort, while 5 of the 10 donors older than 19 years complained of mild headache and malaise. Overall, the incidence of G-CSF-related toxic reactions was low in the very young pediatric donors. Since the first allogeneic PBSC transplantation was reported in 1992, PBSC transplantation has been increasingly used for the treatment of various hematologic diseases and solid tumors due to its rapid post-transplant hematopoietic reconstitution and ease of harvesting. Although the number of PBSC transplantation donor studies is small and the follow-up period is short, in general donor PBSC has mild adverse effects and is safe for donors.