Filgrastim treatment of acute myelogenous leukemia (M7) relapse after allogeneic peripheral stem cell transplantation resulting in both graft-versus-leukemia effect with cytogenetic remission and chronic graft-versus-host disease manifesting as polyserositis and subsequent bronchiolitis obliterans with organizing pneumonia.
Filgrastim (granulocyte colony-stimulating factor) has recently been reported to successfully treat patients with leukemic relapse after allogeneic peripheral stem cell transplantation (PSCT). However, the majority of the patients who responded also developed graft-versus-host disease (GVHD). Polyserositis as a manifestation of GVHD is a rare phenomenon. We report the first case of polyserositis following the use of filgrastim to treat a patient with acute myelogenous leukemia (M7), who had relapsed after an initially successful allogeneic PSCT. The polyserositis manifested with effusions and was initially controlled with high doses of steroids and pericardial stripping; however, after a quiescent period the patient eventually developed bronchiolitis obliterans with organizing pneumonia that required additional immunosuppressive therapy. We review the literature on GVHD-associated polyserositis and offer potential explanations for its pathogenesis.
Law
L
L
Division of Hematology/Oncology, Department of Internal Medicine, University of California, Davis, California, USA.
Tuscano
J
J
Wun
T
T
Ahlberg
K
K
Richman
C
C
D000293:Adolescent; D002908:Chronic Disease; D018549:Cryptogenic Organizing Pneumonia / Q000139:chemically induced / Q000209:etiology*; D020732:Cytogenetic Analysis; D005260:Female; D000069585:Filgrastim; D006086:Graft vs Host Disease / Q000139:chemically induced / Q000209:etiology / Q000473:pathology; D020544:Graft vs Leukemia Effect; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D007947:Leukemia, Megakaryoblastic, Acute / Q000150:complications* / Q000188:drug therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D011994:Recombinant Proteins; D012074:Remission Induction / Q000379:methods; D012700:Serositis / Q000139:chemically induced / Q000209:etiology*; D014184:Transplantation, Homologous
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim