Risks of rhG-CSF treatment in drug-induced agranulocytosis

Abstract

Nine patients with drug-induced agranulocytosis received recombinant human granulocyte colony-stimulating factor (rhG-CSF) to accelerate myeloid recovery because of life-threatening infections related to neutropenia. All patients showed a quick recovery of their granulocyte counts. Side effects were substantial, however. Three patients, two with a severe infection and one with preexisting pulmonary infiltrates, developed worsening of their respiratory status during neutrophil recovery, resulting in clinical manifestations of the adult respiratory distress syndrome (ARDS). In view of these major complications, the exact place of hematopoietic growth factors in the treatment of drug-induced agranulocytosis remains to be determined.

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

“…Since that time, others have reported similar findings [9,10,12,13,14], including several studies that have assessed risk of WRS in critically ill patients [9,12,14]. For example, up to half of critically ill cancer patients with NR experience WRS [1,12].…”

“…Of interest, WRS has been associated with increased lung microvascular permeability in one of the reported patients [8]. Moreover, Demuynck et al [13] emphasized that preexisting lung injury or severe infection was observed in each of their patients. Our study suggests that up to one third of hematology patients with an expected neutropenia duration of more than 7 days experience this event.…”

“…For example, up to half of critically ill cancer patients with NR experience WRS [1,12]. Information about noncritically ill patients is scarce, however, and relies mainly on small case series [8,10,13]. Of interest, WRS has been associated with increased lung microvascular permeability in one of the reported patients [8].…”

“…These include longer neutropenia duration [9], preexisting respiratory failure or infection [8,12,13,15], the need for mechanical ventilation [12], and G-CSF use [11,13,16]. Nevertheless, the pathophysiology of WRS remains debated.…”

“…Up to 50% of critically ill patients experience a deterioration of their respiratory status during NR [9,11,12], but little information is available for less severe hematological patients (i.e. neutropenic patients who did not require ICU admission) [8,10,13]. NR has been reported to be associated with the deterioration of oxygenation and changes in lung microvascular permeability [8]; however, the small number of reported cases outside of the ICU, the lack of adequate evaluation of the incidence density of respiratory deterioration during NR, and the lack of comparison with acute respiratory failure during neutropenia has left a need for additional studies in this patient population.…”