title: Severe chronic neutropenia: treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry.
abstract: Severe chronic neutropenia (SCN) is defined as an absolute neutrophil (ANC) of less than 0.5 x 10(9)/L, lasting for months or years. Congenital, cyclic, and idiopathic neutropenia are principal categories of SCN. Since 1994, the Severe Chronic Neutropenia International Registry (SCNIR) has collected data to monitor the clinical course, treatments, and disease outcomes for SCN patients. This report summarizes data for 853 patients, almost all treated with daily or alternate-day recombinant human granulocyte colony-stimulating factor (G-CSF or Filgrastim). G-CSF treatment increased the ANC overall from 0.34 x 10(9)/L +/- 0.018 pre-treatment to 3.70 x 10(9)/L +/- 0.18 during the first year of treatment. For most patients, the responses were durable with patients remaining on the same dose of G-CSF for many years. Long-term hematological observations showed stable mean leukocyte and neutrophil counts and gradually increasing hemoglobin levels. Thrombocytopenia developed in 4% of patients. As of January 1, 2000, myelodysplasia (MDS) or acute myelogenous leukemia (AML) has occurred in 35 of 387 patients with congenital neutropenia with a cumulative risk of 13% after 8 years of G-CSF treatment. This event occurred without a predictable relationship to the duration or dose of G-CSF treatment. No patients with cyclic or idiopathic neutropenia developed MDS or AML. Other important adverse events included hepatomegaly, osteoporosis, vasculitis, glomerulonephritis, and deaths in 4 of 14 cases requiring splenectomy. Growth and development and the outcome of pregnancy appeared to be unaffected by G-CSF treatment. These data indicate that congenital, cyclic, and idiopathic neutropenia can be effectively treated with long-term G-CSF. The risk of leukemia, osteoporosis, other potentially adverse events, and pregnancy outcome need to be further evaluated with continuing long-term observations.
authors.affiliation: Department of Medicine, Box 356422, University of Washington, Seattle, WA 98195, USA. dcdale@u.washington.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Dale
authors.forename: Tammy E
authors.initials: TE
authors.lastname: Cottle
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Fier
authors.forename: Audrey Anna
authors.initials: AA
authors.lastname: Bolyard
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Bonilla
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Boxer
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cham
authors.forename: Melvin H
authors.initials: MH
authors.lastname: Freedman
authors.forename: George
authors.initials: G
authors.lastname: Kannourakis
authors.forename: Sally E
authors.initials: SE
authors.lastname: Kinsey
authors.forename: Robert
authors.initials: R
authors.lastname: Davis
authors.forename: Debra
authors.initials: D
authors.lastname: Scarlata
authors.forename: Beate
authors.initials: B
authors.lastname: Schwinzer
authors.forename: Cornelia
authors.initials: C
authors.lastname: Zeidler
authors.forename: Karl
authors.initials: K
authors.lastname: Welte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002471:Cell Transformation, Neoplastic; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006128:Growth; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D010024:Osteoporosis; D011247:Pregnancy; D012042:Registries; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor