Stimulation of myelopoiesis in a patient with congenital neutropenia: biology and nature of response to recombinant human granulocyte-macrophage colony-stimulating factor.
To stimulate granulopoiesis, we gave recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF; 120 microgram/m2/d) to a patient with congenital neutropenia. The treatment resulted in marked increases in white blood cell counts (maximum, 17,400/microL), consisting mainly of eosinophils (maximum, 13,050/microL) and monocytes (maximum, 1305/microL), rather than neutrophils (maximum, 798/microL). Circulating phagocytes (97% eosinophils) derived after GM-CSF treatment were less effective in chemotaxis, slower but equally effective in phagocytosis, and more effective in H2O2 production compared with normal control neutrophils, but comparable in chemotaxis and H2O2 production to control eosinophils. Before GM-CSF treatment, the bone marrow showed a maturation defect in the neutrophilic series that persisted after treatment despite marked increases in mature cells of other lineages. In vitro agar culture of bone marrow cells before GM-CSF treatment showed a normal number of granulocyte colonies; however, maturation was limited to the metamyelocyte stage. Although the absolute number and cycling rates of myeloid colony forming cells (predominantly eosinophils) increased after treatment, the maturation defect in the neutrophilic series persisted. The finding that GM-CSF induced stimulation of proliferation, which was coupled with maturation in the eosinophilic and monocytic but not the neutrophilic components, suggests that this patient had an intrinsic cellular or humoral defect in neutrophil maturation.
Department of Clinical Immunology and Biological Therapy, University of Texas M.D., Anderson Cancer Center, Houston 77030.
S
S
Vadhan-Raj
S S
SS
Jeha
S
S
Buescher
A
A
LeMaistre
G
G
Yee
L
L
Lu
J
J
Lloreta
W K
WK
Hoots
W N
WN
Hittelman
J U
JU
Gutterman
D000293:Adolescent; D000380:Agranulocytosis / Q000188:drug therapy*; D001853:Bone Marrow / Q000187:drug effects / Q000648:ultrastructure; D001854:Bone Marrow Cells; D002455:Cell Division / Q000187:drug effects; D003115:Colony-Stimulating Factors / Q000494:pharmacology / Q000627:therapeutic use*; D004341:Drug Evaluation; D004804:Eosinophils / Q000187:drug effects / Q000648:ultrastructure; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D006133:Growth Substances / Q000494:pharmacology / Q000627:therapeutic use*; D006410:Hematopoiesis / Q000187:drug effects*; D006412:Hematopoietic Stem Cells / Q000187:drug effects; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D009000:Monocytes / Q000187:drug effects / Q000648:ultrastructure; D009503:Neutropenia / Q000151:congenital / Q000188:drug therapy* / Q000473:pathology; D009504:Neutrophils / Q000187:drug effects / Q000648:ultrastructure; D010586:Phagocytes / Q000187:drug effects / Q000502:physiology / Q000648:ultrastructure; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use
D003115:Colony-Stimulating Factors; D006133:Growth Substances; D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor