title: Capillary leak syndrome during low dose granulocyte-macrophage colony-stimulating factor (rh GM-CSF) treatment of a patient in a continuous febrile state.
abstract: A 20 years old man with peripheral primitive neuroectodermal tumor involving the bone marrow received 12 Gy fractionated total body irradiation, 140 mg/m2 melphalan, 1800 mg/m2 etoposide, and 1500 mg/m2 carboplatin for consolidation of first remission. Thereafter, 250 micrograms/m2/day recombinant human granulocyte-macrophage colony-stimulating factor (rh GM-CSF) (Behring Werke) were administered as continuous infusion 4 days after infusion of autologous bone marrow and peripheral stem cells to accelerate granulocyte reconstitution for control of a continued febrile state. The clinical picture of capillary leak syndrome developed with weight gain, pleural effusions and peripheral edema. The patient's condition stabilized after discontinuation of rh GM-CSF. Eight days later he died of invasive aspergillosis. The clinical course of our patient suggests a potentially fatal toxic effect of rh GM-CSF, even in low dose, in the setting of septicemia or fungemia.
authors.affiliation: St. Anna Children's Hospital, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Emminger
authors.forename: W
authors.initials: W
authors.lastname: Emminger-Schmidmeier
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Susani
authors.forename: R
authors.initials: R
authors.lastname: Hawliczek
authors.forename: P
authors.initials: P
authors.lastname: Höcker
authors.forename: H
authors.initials: H
authors.lastname: Gadner
mesh_terms: D000328:Adult; D002199:Capillary Permeability / Q000502:physiology*; D005334:Fever / Q000188:drug therapy*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012769:Shock / Q000097:blood* / Q000139:chemically induced
chemical_list: D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor