Capillary Leak Syndrome Likely the Result of Granulocyte Colony-Stimulating Factor after High-Dose Chemotherapy.

Abstract

Twocases of malignant lymphomacomplicated with capillary leak syndrome following super high-dose chemotherapy and administration ofgranulocyte colony-stimulating factor (G-CSF) are presented. Subsequent to the nadir of granulocytes, and at the stage of rapid increase of granulocytes, the symptoms of fever, hypotension, dyspnea, pleural eflusion and edema appeared, and laboratory data revealed hypoxia, hypocapnia and hypoalbuminemia. In addition, an abscesslike lesion was observed in the liver in one patient. After the administration of G-CSFwas ceased or decreased, and pulse therapy with methylprednisolone was initiated, these symptoms disappeared quickly.

Systemic Capillary Leak Syndrome Caused by Granulocyte Colony-Stimulating Factor

“…In the case reported by Nakagawa et al, the cause of SCLS was idiopathic; they speculated on the cause of an increased serum level of G-CSF among the various cytokines measured according to the severity or exacerbation of SCLS (1). Our cases were observed after the administration of G-CSF at the nadir of neutropenia after high-dose chemotherapy with or without autologous hematopoietic stem cell transplantation (HSCT) (2). These results demonstrate that G-CSF is responsible for the pathogenesis of SCLS, irrespective of whether the serum level increases idiopathically or after therapeutic administration.…”

“…The symptoms of SCLS in these cases were ameliorated by the administration of corticosteroids (1,2). Medical professionals should in mind this particular adverse effect of G-CSF.…”

“…As early as 1994, we reported two cases of malignant lymphoma causing SCLS in Internal Medicine (2). In the case reported by Nakagawa et al, the cause of SCLS was idiopathic; they speculated on the cause of an increased serum level of G-CSF among the various cytokines measured according to the severity or exacerbation of SCLS (1).…”

Unusual adverse events following peripheral blood stem cell (PBSC) mobilisation using granulocyte colony stimulating factor (G-CSF) in healthy donors

“…G-CSF has been discussed as the causative agent for the occurrence of Sweet syndrome, leukocytoclastic vasculitis, interstitial pneumonitis, adult respiratory distress syndrome (ARDS), pyoderma gangraenosum, capillary leakage, stroke, acute gouty arthritis, iritis, severe anaphylactoid reactions, and non-traumatic rupture of the spleen. 11,[16][17][18][19][20][21][22][23][24] On the other hand, growth factors such as G-CSF and GM-CSF have been proven to reduce the incidence of documented infections in neutropenic patients and they have been shown to reduce the risk of pyogenic infections in patients with chronic granulomatous disease. 25 In contrast, by increasing the activity of the oxidative burst in neutrophils a pathophysiological role of these substances in augmenting inflammatory processes in persons or patients with normal or even subnormal neutrophil counts and/or function must be discussed (for summary see Spiekermann et al 16 ).…”

Systemic Capillary Leak Syndrome Caused by Granulocyte Colony-Stimulating Factor

“…Moreover, increased levels of G-CSF have been reported after infusions of IL-2, IL-4, IL-6, tumor necrosis factor, and granulocyte-macrophage colony-stimulating factor as well as after allogeneic hematopoietic stem cell transplantation (1,2,5). Therefore, in some SCLS, G-CSF might be useful biomarker for the severity of attacks in SCLS, but not in all cases.…”