Granulocyte colony-stimulating factor (G-CSF) dependent hematopoiesis with monosomy 7 in a patient with severe aplastic anemia after ATG/CsA/G-CSF combined therapy

Manabu Nishimura, Tetsuya Yamada, Toshihiko Andoh, Tsuyoshi Tao, Masahiro Emoto, Toshiaki Ohji, Kazuyuki Matsuda, Naoko Kameda, Yutaka Satoh, Akira Matsutani, Yoichi Azuno, Yoshitomo Oka

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9 Citations (Scopus)

Abstract

We report a case of secondary myelodysplastic syndrome (MDS) with monosomy 7, which evolved from severe aplastic anemia (SAA) after long-term use of granulocyte colony-stimulating factor (G-CSF). A 36 year old female was admitted for detailed examination and treatment of pancytopenia. SAA was diagnosed based on hypoplastic bone marrow and a normal chromosome study. She was treated with anti-thymocyte globulin (ATG), ciclosporin A (CsA) and G- CSF, which resulted in gradual improvement of not only the myeloid but also the erythroid-megakaryocyte series. However, bone marrow dysplasia with monosomy 7 was observed after 7 months of a combination therapy of immunosuppressant and G-CSF, which prompted the discontinuation of G-CSF administration. Thereafter, bone marrow hypoplasia gradually progressed, resulting in a second aplastic crisis. During this process, the proportion of marrow cells showing monosomy 7 decreased, and the proportion with normal karyotype increased. Re-administration of G-CSF induced a trilineage, though dysplastic, hematological response; but the monosomy 7 positive population increased again. These observations indicated the presence of G-CSF dependent hematopoiesis associated with monosomy 7 in this patient. Although many G- CSF related MDS/AML cases with this leukemia-specific abnormal karyotype have been reported with emphasis on the harmful effects of G-CSF, G-CSF was useful even after the appearance of monosomy 7 as a means of avoiding life- threatening infection in this patient.

Original languageEnglish
Pages (from-to)203-211
Number of pages9
JournalInternational journal of hematology
Volume68
Issue number2
Publication statusPublished - 1998 Aug 1

Keywords

  • Aplastic anemia
  • Granulocyte colony stimulating factor
  • Monosomy 7

ASJC Scopus subject areas

  • Hematology

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