Transient atypical monocytosis mimic acute myelomonocytic leukemia in post-chemotherapy patients receiving G-CSF: report of two cases.
Granulocyte colony-stimulating factor (G-CSF) is now widely used in patients with malignant disorders receiving intensive chemotherapy to increase leukocyte count and to upregulate phagocyte function during neutropenia. Monocytosis associated with G-CSF has been reported in anecdotal literature. We report two cases of pseudoleukemia secondary to G-CSF administration. Both patients initially presented with myelodysplastic syndrome with chromosome 7 abnormalities that evolved into acute myeloid leukemia. Case one had deletion 7q while case two initially had monosomy 7 and subsequently developed a balanced translocation between the short (p) arm of chromosome 1 and long (q) arm of chromosome 15. Following the induction chemotherapy and G-CSF administration, both of these patients developed pseudoleukemia. Patient 1 had white blood cell (WBC) count of 26 x 10(9)/l with 72% monocytes, while patient two had WBC of 14.1 x 10(9)/l with 30% monocytes. In both patients the monocytosis resolved after the discontinuation of G-CSF therapy. In summary, patients treated with G-CSF should be followed closely. In those cases with pseudoleukemia discontinuation of the drug with no supplemental chemotherapy is probably enough to control the atypical monocytosis.
Department of Pathology, Hematopathology/Molecular Pathology Laboratories, New York University School of Medicine, New York, NY 10016, USA. liuc06@med.nyu.edu
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CZ
Liu
R
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Persad
G
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Inghirami
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Sen
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Amorosi
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A
Goldenberg
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Ibrahim
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002869:Chromosome Aberrations; D003582:Cytogenetics; D003937:Diagnosis, Differential; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000209:etiology / Q000235:genetics; D015479:Leukemia, Myelomonocytic, Acute / Q000175:diagnosis*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D009000:Monocytes / Q000166:cytology / Q000187:drug effects*; D009190:Myelodysplastic Syndromes / Q000473:pathology
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor