Lineage-unrestricted hematologic response to granulocyte colony-stimulating factor in a patient with refractory anemia with excess blasts.
We report a patient with refractory anemia with excess blasts who showed a lineage-unrestricted hematologic response to granulocyte colony-stimulating factor (G-CSF). After 17 months of a stable disease state, the patient developed pneumonia, progression of cytopenia, and reduced cellularity and blast mass in the bone marrow. He was given G-CSF to overcome the pneumonia. Not only the neutrophil count, but also the platelet count increased soon after initiation of the G-CSF therapy; both counts became normal on the fifth day of the G-CSF therapy. Additionally, the anemia improved gradually. The neutrophil and platelet counts were maintained in the normal range for 3 months after cessation of the G-CSF. In vitro studies showed that G-CSF alone stimulated megakaryocyte colony formation from bone marrow mononuclear cells (BMMNC), and accessory cells in the BMMNC were necessary for expression of this G-CSF-induced in vitro megakaryocytopoiesis. These results suggest that, in coordination with accessory cells, G-CSF stimulated megakaryocytopoiesis in the patient. This case provides valuable information for understanding the mechanisms of a lineage-unrestricted hematologic response to G-CSF, which is very rarely observed in MDS.
Yokose
N
N
Third Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Ogata
K
K
An
E
E
Tamura
H
H
Kamikubo
K
K
Dan
K
K
Nomura
T
T
D000754:Anemia, Refractory, with Excess of Blasts / Q000188:drug therapy*; D001853:Bone Marrow / Q000187:drug effects; D001854:Bone Marrow Cells; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006410:Hematopoiesis / Q000187:drug effects; D006801:Humans; D008297:Male; D008533:Megakaryocytes / Q000166:cytology; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology / Q000187:drug effects
D016179:Granulocyte Colony-Stimulating Factor