Prophylactic oral calcium–vitamin D3 –magnesium supplementation reduced citrate‐related reactions during peripheral blood stem cell collection in healthy donors: A randomized controlled trial

BACKGROUND: Citrate-related reactions remain the most common adverse events during peripheral blood stem cell (PBSC) collection despite routine prophylactic intravenous calcium administration. We evaluated whether prophylactic oral calcium-vitamin D3-magnesium supplementation reduces citrate-related reactions in healthy PBSC donors. STUDY DESIGN AND METHODS: In this prospective open-label randomized controlled trial, 52 healthy allogeneic PBSC donors were randomly assigned to receive prophylactic oral calcium-vitamin D3-magnesium supplementation before PBSC collection (n = 26) or no oral supplementation (n = 26). The primary endpoint was Grade ≥1 citrate-related reactions. Secondary endpoints included Grade ≥2 reactions, electrolyte-related outcomes, and safety. RESULTS: All randomized donors completed the study and were included in the final analysis. Grade ≥1 citrate-related reactions occurred in 8 of 26 donors (30.8%) in the control group and in none of the intervention group (RR, 0.000; 95% CI, 0.000-0.000; p < .001). Grade ≥2 reactions occurred in two donors (7.7%) in the control group and in none of the intervention group. One donor in the control group developed Grade 4 tetany near the end of PBSC collection, after which the procedure was terminated. No Grade 4 reactions occurred in the intervention group. No statistically significant between-group differences were observed in electrolyte-related outcomes. CONCLUSION: Prophylactic oral calcium-vitamin D3-magnesium supplementation markedly reduced citrate-related reactions during PBSC collection in healthy donors and may represent a practical approach to improving donor safety.