Nonchemotherapy drug-induced agranulocytosis in elderly patients: the effects of granulocyte colony-stimulating factor.
OBJECTIVE
Elderly patients with nonchemotherapy drug-induced agranulocytosis present commonly with severe infections, and have a mortality of at least 20%. We studied whether granulocyte colony-stimulating factor (G-CSF), a hematopoietic growth factor that shortens the duration of neutropenia, is useful in these patients.


METHODS
We studied 54 patients > or =65 years of age who had drug-induced agranulocytosis, some of whom had been treated with G-CSF. We determined the times until hematologic recovery (defined as a neutrophil count >1.5 x 10(9)/L), tolerance of G-CSF, and clinical outcomes.


RESULTS
Of the 54 patients, 20 received G-CSF. Two patients who had not been treated with G-CSF died of uncontrolled septic shock and extensive pneumonia. The mean (+/- SD) time until hematologic recovery was significantly less in patients treated with G-CSF (6.6 +/- 3.9 days vs. 8.8 +/- 4.9 days, P <0.04). Compliance with G-CSF therapy was good; only mild flu-like symptoms and transient bone pain were reported in 12 patients.


CONCLUSIONS
Our findings suggest that G-CSF therapy may be beneficial in the management of drug-induced agranulocytosis in elderly patients.
Andrès
Emmanuel
E
Department of Internal Medicine, Hôpitaux Universitaires of Strasbourg, Strasbourg, France.
Kurtz
Jean Emmanuel
JE
Martin-Hunyadi
Catherine
C
Kaltenbach
Georges
G
Alt
Martine
M
Weber
Jean Christophe
JC
Sibilia
Jean
J
Schlienger
Jean Louis
JL
Dufour
Patrick
P
Maloisel
F rédéric
Fr
D000368:Aged; D000369:Aged, 80 and over; D000380:Agranulocytosis / Q000139:chemically induced* / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D013956:Antithyroid Agents / Q000009:adverse effects; D005260:Female; D005602:France; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D010349:Patient Compliance; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013956:Antithyroid Agents; D010975:Platelet Aggregation Inhibitors; D016179:Granulocyte Colony-Stimulating Factor