Granulocyte colony-stimulating factor (G-CSF) treatment in a neutropenic leukemia patient with diffuse interstitial pulmonary infiltrates

Abstract

Adult respiratory distress syndrome (ARDS) in patients suffering from acute leukemia usually occurs during chemotherapy-induced neutropenia. In addition, intensified chemotherapy with high-dose cytosine arabinoside and mediastinal irradiation may contribute to the development of ARDS. This complication is usually refractory to conservative treatment with antibiotics, steroids, and mechanical ventilation. In this report, we describe a 25-year-old patient with acute lymphoblastic leukemia who developed ARDS during the phase of chemotherapy-induced neutropenia. Subcutaneous administration of granulocyte colony-stimulating factor (G-CSF) at doses of 300-600 micrograms/day led to a prompt increase of peripheral granulocyte counts. With resolution of neutropenia, respiratory function gradually improved, and mechanical ventilatory support was stopped after 2 weeks. From this observation we surmise that the application of G-CSF may be an effective therapeutic approach for preventing the fatal outcome of ARDS in leukemia patients with bone marrow aplasia.

Effect of Granulocyte/Colony-Stimulating Factor on the Onset of the Adult Respiratory Distress Syndrome

“…This suggested that early and steep recovery of neutrophil counts following severe neutropenia contributed to the development of pulmonary interstitial infiltration and possibly ARDS. In contrast, other authors [10, 19, 20, 21, 22]noted that ARDS was likely to occur during neutropenia. Apart from the complement-neutrophil pathway, they assumed that other mediators of the inflammatory pathway play important roles in the development of ARDS [22, 23].…”

“…Similarly, Heyll et al [10]reported an incidence of ARDS of 11% in patients with acute leukemia who received chemotherapy without G-CSF. Consequently the incidence of ARDS in our department was regarded as common.…”

Invasive pulmonary aspergillosis resulting in respiratory failure during neutrophil recovery from postchemotherapy neutropenia in three patients with acute leukaemia

“…In its attempt to activate or increase the neutrophil count, G‐CSF perhaps contributes to the development of ARDS [5, 6]. There have been cases of ARDS or interstitial pneumonia associated with G‐CSF [5, 7–11]; there have also been cases where ARDS improved whilst G‐CSF was being given and the neutrophil count was increasing [12]. In cases of neutropenia where pulmonary infection coexisted with the use of G‐CSF, ARDS seemed to worsen [5].…”

Acute respiratory distress syndrome due to methicillin-resistant Staphylococcus aureus sepsis in hyper-IgE syndrome

“…Although rhG-CSF may exert a potential negative effect on the course of ARDS by activating neutrophils leading to the release of some mediators, the application of rhG-CSF was an effective therapeutic approach for preventing the fatal outcome of ARDS. Whilst neutrophil depletion prevents lung injury in a variety of intact animal models [23], HEYLL et al [24] reported that administration of rhG-CSF resulted in a successful outcome in a neutropenic leukaemia patient with ARDS. KOIZUMI et al [25] reported that G-CSF, in spite of the increase in peripheral neutrophil count, did not aggravate lung injury induced by endotoxin in a sheep model.…”