Granulocyte Colony Stimulating Factor (G-CSF) Induced Splenic Infarction in Breast Cancer Patient Treated with Dose-Dense Chemotherapy Regimen

Abstract

Introduction. Granulocyte colony-stimulating factor (G-CSF) is commonly used for prevention and treatment of febrile neutropenia among solid tumor patients. It is considered an effective and relatively safe supportive care medication; however, it can cause rare and serious side effects such as spleen rupture or infarction. Case Presentation. We are reporting a case of a 27-year-old female with breast cancer who has been treated with dose-dense chemotherapy and received colony-stimulating factor as primary prevention of febrile neutropenia that was complicated halfway through with splenic infarction. This finding was confirmed by computed tomography (CT) scan and splenic biopsy. Management was conservative without the need of surgical intervention. Conclusion. Although splenic infarction is an extremely rare side effect of G-CSF, it can be a serious complication that should be recognized, monitored, and managed carefully.

Vertebral fracture and splenomegaly in a head and neck cancer producing granulocyte colony‑stimulating factor: A case report of systemic complications associated with a cytokine‑producing solid tumor

“…According to Khinji and ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2018 2019 2020 - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Linenberger (14), of 2,992 cases of adverse events linked to rhG-CSF preparations, 15 (0.5%) included splenomegaly; in addition, Aubrey-Bassler and Sowers (15) reported that, of 613 cases of splenic rupture, 10 (1.6%) were associated with rhG-CSF preparations. There are several case reports of splenic rupture and infarction when rhG-CSF preparations were administered to patients with cancer for the purpose of treating or preventing myelosuppression by chemotherapy and to healthy donors prior to stem cell transplantation (16)(17)(18)(19). However, the PubMed search revealed no reports of splenomegaly hypothetically associated with G-CSF produced by solid tumors, other than the present case and a previously reported case by de Wolff et al (20).…”

“…According to Khinji and Linenberger ( 14 ), of 2,992 cases of adverse events linked to rhG-CSF preparations, 15 (0.5%) included splenomegaly; in addition, Aubrey-Bassler and Sowers ( 15 ) reported that, of 613 cases of splenic rupture, 10 (1.6%) were associated with rhG-CSF preparations. There are several case reports of splenic rupture and infarction when rhG-CSF preparations were administered to patients with cancer for the purpose of treating or preventing myelosuppression by chemotherapy and to healthy donors prior to stem cell transplantation ( 16-19 ). However, the PubMed search revealed no reports of splenomegaly hypothetically associated with G-CSF produced by solid tumors, other than the present case and a previously reported case by de Wolff et al ( 20 ).…”