Bone marrow necrosis in a patient with acute myeloblastic leukemia during administration of G-CSF and rapid hematologic recovery after allotransplantation of peripheral blood stem cells

Abstract

Allogeneic peripheral blood stem cell transplantation from an HLA-identical sibling was performed for a 38-year-old male with refractory acute myeloblastic leukemia. The patient was conditioned with total body irradiation (TBI) and high-dose cytosine arabinoside (Ara-C). G-CSF (300 microg/body) was started for priming of residual leukemic cells 24 hr before the beginning of TBI (day -9). However, intolerable generalized bone pain appeared shortly after the start of first dose of G-CSF, and persisted for 3 days in spite of the cessation of G-CSF. Posttransplant hematopoietic engraftment was very rapid. Bone marrow biopsy specimens on day 14 and 30 showed typical bone marrow necrosis histologically. This is the first case of bone marrow necrosis during administration of G-CSF, and our experience suggests that PBSC could repopulate hematopoiesis in spite of severe bone marrow necrosis.

Bone Marrow Necrosis: Report of Five Cases and Review of the Literature

“…[3][4] In this study, the BMN had different underlying disease processes that were initially obscured in some patients because of the necrosis, just as in previous reports. [5][6][7][8][9][10][11][12][13][14][15][16] Similar to the report of Niebrugge et al, 16 BMN preceded the diagnosis of ALL in our case 5, while in case 2, the diagnosis was not established, as the patient died early. For case 1, BMN was the result of chemotherapy, while in case 3, it was associated with metastatic carcinoma, as in a previous report, 10 which in our case, was documented by immunohistochemistry ( Figure 2).…”

“…[2][3][4][5][6][7][8][9][10] It has also been related to the presence of antiphospholipid antibodies 4 and chemotherapy for cancer with a variety of agents. [11][12][13][14] The pathophysiology of BMN has been a subject of controversy and debate, 3 and has included toxic effects of chemotherapy, microvascular infarction, decreased oxygen tension due to increased proliferative capacity of infiltrating malignant cells, 3 tumor necrosis factor (TNF), 17 and thrombosis. [3][4] In this study, the BMN had different underlying disease processes that were initially obscured in some patients because of the necrosis, just as in previous reports.…”

Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies

“…32 In the post transplant period, pain syndromes, such as bone pain, myalgia, headaches and neuropathic pain, have been reported and have been attributed to the administration of CYA 33 and/or G-CSF. 34 In addition, BM necrosis, a rare but dramatic and very painful complication, has been described in patients undergoing allogeneic HSCT following G-CSF administration 35 or due to acute GVHD. 36 Lastly, other painful complications have been observed during the transplant phase; they may be associated with bacterial pneumonia, abscesses, cellulitis and abdominal infections.…”

Bone marrow necrosis: Clinicopathologic analysis of 20 cases and review of the literature

“…Sickle cell disease (SCD), infections, sepsis, and drug ingestion are nonmalignant causes of BMN [16][17][18][19][20][21][22][23][24][25]. Some cytokines and new antineoplastic drugs, such as interferon alpha, G-CSF, ATRA, and fludarabine, which are commonly used drugs in hematology-oncology practice, may cause BMN [26][27][28][29][30][31]. More rare causes of BMN are anorexia nervosa and hemolytic uremic syndrome (HUS), antiphospholipid syndrome (APS), and DIC, which is generally associated with disseminated metastatic disease and hyperparathyroidism [32][33][34][35][36][37][38][39].…”