Trilineage response to recombinant human granulocyte colony‐stimulating factor administration in a patient with myelodysplastic syndrome

Abstract

Hagino H. Three cases ofosteoinalacia caused by intravenoub administration of saccharaied ferrlc oxide. Seikeigeka Saigaigeka 3:l 182-1 185. 1990. 4. Mizumoto H, ltota A. Mashio Y, Tauji T. Takakahashi H: A case ot osteoiiialacin caused by intravcnous administration of saccharaicd fcrric oxidc. Naika 65593-596. 1990. 5 . Okada M. lida M. Iniamura K, Turuta 0. Egashira Y, Murakami M. Oogushi H. Matui T, Omae T: Elfecr of intravenous infusion of saccharated fcrric oxide in hypophosphatemia. Igakunoayumi I 17:21-24. 19x1 Trilineage Response to Recombinant Human Granulocyte Colony-Stimulating Factor Administration in a Patient With Myelodysplastic Syndrome To /he Editor; Washizuka et al. [ I I recently reported a patient with myelo-dysplaatic syndrome who exhibited a significant increase in granulocyte as well as in erythrocyte and platelet counts after administration of recombinant human granulocyte colony-stimulating factor (rHuG-CSF). We report il similar case An 18-year-old man was admitted in February, 1990, for evaluation of pallor and fatigue. Results of blood tests were as follows: hemoglobin 6.5 gidl. mean corpuscular volume (MCV) I16 tl, reticulocytes 35 x 1OY/liter; white blood cells 3.9 X 10qiliter with 34% neutrophils, 2% eosinophils, 59% lymphocytes, and 5% monocytes: platelets 61 X 10y/liter. The bone marrow cellularity was increased, with 49%> granulocytes, 4 1 % erythroblasts, and megakaryocytes within the normal range: dyserythropoiesis was observed, with macro-and niegaloblasts, intranuclear chromatin, and intercytoplasmic bridges, binucleated erythrohlasts. and Howell-Jolly bodies together with an excess of inyeloblasts (13%). Sixty-seven percent of erythrohlasts contained iron after Perk staining, but no ring sideroblastc were found. Fetal hemoglobin (HbF) level was 7.710. The patient was diagnosed with refractory anemia with exceqs blasts (RAEB) according to FAB classification. Cytogenetic examination showed a normal marrow kayotype in 100% of 40 metdphases analyzed. Due to the absence of a histocompatible sibling. search for an unrelated bone marrow donor was initiated.During the first year from diagnosis, severe anemia required multiple kransfusions (three or four red blood cell concentrates per month); platelet counts ranged between 40 and 60 X IO'iliter, and neutrophils were stable at -I X 10y/liter. After an infection in February, 1991, subcutaneous rHuG-CSF (Lenograstim) was started at an initial dose of 5 pg/kg/day. reduced after I month to 5 kglkgievery other day for I year and subsequently to 5 psikg twice per week. As is shown in Figure I , a rise in neutrophils to normal values occurred within the first days of treatment and was steadily maintained. Moreover, a response was also observed in erythroid and inegakaryocytic lineages: The patient became transfusion independent I month after onset of rHuG-CSF administration, while platelet counts rose gradually to normal values within 5 months and were maintained thereafter. Bone marrow examination after 10 months of rHuG-CSF therapy disclo...