Filgrastim (r-metHuG-CSF) reversal of drug-induced agranulocytosis

Nonchemotherapy Drug‐Induced Agranulocytosis: A Review of 118 Patients Treated with Colony‐Stimulating Factors

“…Fever, skin rash, musculoskeletal pain, flare-up of arthritis, and headache were noted in our review, and also were previously reported. 10,12,13,15 Other possible adverse reactions include increases in serum uric acid levels, serum creatinine, 68 and lactate dehydrogenase activity, 10 although they did not occur in patients we reviewed. Therefore, administration of CSFs for the treatment of DIA appears to be safe, but careful monitoring for adverse reactions is important.…”

“…Overall, the mean dosage was 5.5 ± 2.4 µg/kg/day and 73 patients (66.4%) received less than 5 µg/kg/day. The total duration 15 1 6 Phenobarbital, phenytoin 15 1 6 Captopril, ranitidine 56 1 7 Ritodrine, indomethacin 57 1 7 Imipenem, tobramycin 33 1 7 Propylthiouracil x 18 days, methimazole x 2 days 46 1 7 Captopril, procainamide, bumetadine, chlorpropamide 58 1 7 Quinidine, ranitidine 45 1 Died Totals 90 7.7 ± 5.1 a Number of days with neutrophil count 0.5 x 10 3 /mm 3 or less. of neutropenia was 6.8 ± 4.8 days (1 death) and 7.1 ± 5.6 days (2 deaths) in patients treated with less than and more than 5 µg/kg/day, respectively (difference 0.3 days, 95% CI -1.9-2.5).…”

“…15 Adverse reactions to CSF were reported in 13 patients. 3,12,13,15,48,61 They included skin rash (3 with GM-CSF, 12 1 with G-CSF 3 ), headache (2 with G-CSF), 15 acute respiratory distress syndrome (2 with G-CSF), 3 acute respiratory distress syndrome with pulmonary edema (1 with G-CSF), 3 fever (1 with GM-CSF), 48 mild bone pain (1 with G-CSF), 15 and musculoskeletal pain in the legs and arms (1 with GM-CSF). 61 A patient treated with G-CSF experienced polyarthralgia, swelling at bilateral elbow joints, and flare-up of arthritis.…”

Drug-induced agranulocytosis

“…Evaluation of efficacy is based on case reports and small series involving patients with agranulocytosis caused by a range of drugs, including clozapine, antithyroid drugs, sulphasalazine, gold, procainamide and mianserin 9 , 22–24. In a retrospective review of 71 such patients treated with G-CSF or granulocyte macrophage-colony stimulating factor (GM-CSF), the mean time to neutrophil recovery for patients with a neutrophil count of 9/L was 5.4?4.5 days 9.…”

Severe bactrim-induced neutropenia with reversal of CD4+ /CD8+ lymphocyte ratio: response to recombinant human granulocyte-colony stimulating factor (R-metHUG-CSF)

“…Direct bone marrow suppression, immune-mediated mechanisms, peripheral destruction and rapid clearance have been described as possible mechanisms. (Sprikkelman et al 1994;Means et al 1992, Teitelbaum, Bell & Brown, 1993, Yokoyama et al 1992). Genetic predisposition may also play a role (Lieberman et al 1990).…”