Breast Feeding

Acceptability at Recruitment

ACCEPTABLE

Acceptability at CT / Work-Up

QUALIFIED if the donor is sufficiently informed about and accepts the fact that there are limited data on safety or is willing to interrupt breastfeeding (and throw away any expressed milk, “pump and dump”) during mobilization and for three days after PBSC and for at least 24 hours after Bone Marrow Collection (discuss case per case with the attending anesthesiologist).

Individual at Risk

Donor

Justification for Guidance

We generally recommend that breast-feeding mothers do not donate and, regardless of breast-feeding, donation is not permitted within six months of a term pregnancy.

However, many breast-feeding donors who are more than six months following delivery feel very strongly that they would like to donate, and would be prepared to stop or suspend breast-feeding at the time of donation.

PBSC harvest

Breast-feeding donors may donate by PBSC if they are prepared to stop breast-feeding on commencing G-CSF injections and to abstain for three days following their donation. It is safe for the mother to express before this three-day period has expired, but the expressed milk should be discarded.

In donors who breastfeed and are qualified to donate (taking the recovery period after pregnancy into consideration) the concern is that drugs used in the donation procedure may be ingested by and harmful for the infant. In line with this, several donor suitability guidance documents consider uninterruptible breastfeeding a contra-indication for PBSC and ask the donor if she is willing to interrupt breastfeeding during mobilization and for a couple of days after donation. However, G-CSF is a normal component of breast milk. Limited research shows that filgrastim and lenograstim are poorly excreted into breastmilk and are undetectable by 3 days after an injection. Evidence also suggests that G-CSF given to neonates orally is not absorbed in significant quantities. In a single-center crossover study in which 22 infants received 1 dose of rhG-CSF (100 microg/kg) (10 times the subcutaneous dose) orally, no side-effects, safety issues or significant changes in plasma G-CSF concentration were observed. In a placebo controlled study G-CSF was safely given to 8 infants suffering from necrotizing enterocolitis. These studies suggest that G-CSF mainly has a local effect on the GI tract and not systemically.

Bone marrow harvest

Anaesthetic drugs are generally very short-lived in the maternal blood stream. Breast-feeding may continue up until anaesthetic induction prior to the bone marrow harvest, and mothers may recommence feeding 24 hours following recovery from anaesthetic, i.e after 'waking up'. If any other medications are given around the time of the procedure, such as sedating benzodiazepines (e.g. midazolam/diazepam), or opiates (e.g. morphine/codeine) then advice should be sought from the attending anaesthetist.

See also

Pregnancy

Pseudonyms or Related Conditions

Breastfeeding

References

1.Pessach I, Shimoni A, Nagler A. Granulocyte-colony stimulating factor for hematopoietic stem cell donation from healthy female donors during pregnancy and lactation: what do we know? Hum Reprod Update. 2013;19:259–67. [PubMed]

2.Shibata H, Yamane T, Aoyama Y, et al. Excretion of granulocyte colony-stimulating factor into human breast milk. Acta Haematol. 2003;110:200–1. [PubMed]

3.Nelson RC. Granulocyte colony-stimulating factor (G-CSF) in breastmilk of a nursing donor during hematopoietic progenitor cells (HPC) mobilization. Transfusion 2018;58 (Suppl S2):169A. Abstract. doi:10.1111/trf.14903. [CrossRef]

4.Kaida K, Ikegame K, Fujioka T, et al. Kinetics of granulocyte colony-stimulating factor in the human milk of a nursing donor receiving treatment for mobilization of the peripheral blood stem cells. Acta Haematol. 2007;118:176–7. [PubMed]

5.Calhoun DA, Maheshwari A, Christensen RD. Recombinant granulocyte colony-stimulating factor administered enterally to neonates is not absorbed. Pediatrics. 2003;112:421–3. [PubMed]

6.Canpolat FE, Yurdakok M, Korkmaz A, et al. Enteral granulocyte colony-stimulating factor for the treatment of mild (stage I) necrotizing enterocolitis: a placebo-controlled pilot study. J Pediatr Surg. 2006;41:1134–8. [PubMed]

7.Drugs and Lactation Database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501373/

8. Specialist Pharmacy Service. https://www.sps.nhs.uk/medicines/filgrastim/#:~:text=filgrastim

Version

Version 2, Edition 1

Date of Last Update

29/11/2023