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Granulocyte colony stimulating factor administration associated with cerebral hemorrhage in acute promyelocytic leukemia

Leukemia volume 20, pages 1452–1453 (2006)Cite this article

Growth factors are routinely used in the treatment of acute myeloid leukemia (AML), but their effects in acute promyelocytic leukemia (APL) are unknown. Here, we report a patient with APL who was treated with granulocyte colony-stimulating factor (G-CSF) and died of a cerebral hemorrhage.

A 44-year-old woman presented to her primary care physician with a 1-month history of vaginal bleeding. The initial work-up revealed a leukocyte count of 1.2 × 109/l, a hemoglobin level of 2.9 g/dl, and a platelet count of 30 × 109/l. The peripheral blood smear showed 26% blasts and 8% promyelocytes. Bone marrow examination demonstrated 57% promyelocytes and 10% blasts. The patient underwent dilatation and curettage, received red blood cell and platelet transfusions, and was started on filgrastim 5 μg/kg daily. Within 24 h, she developed slurred speech and numbness of the right arm. An MRI of the brain revealed no abnormality. The symptoms progressed to word-finding difficulties and worsening right-sided hemiparesis. Filgrastim was discontinued after only one dose. While undergoing a computed tomography (CT) scan of the brain, the patient had an acute episode of loss of consciousness and became unresponsive. The CT scan demonstrated a 3 × 4-cm intracerebral left frontal hemorrhage with surrounding edema, mass effect, evidence of subfalcine herniation, and early dilatation of the right temporal horn.

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  1. Department of Leukemia, The University of Texas MD, Anderson Cancer Center, TX, Houston, USA

    A-M Tsimberidou, E Estey, H Kantarjian, M J Keating, S Pierce & G Garcia-Manero

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  1. A-M Tsimberidou
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  2. E Estey
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  3. H Kantarjian
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  4. M J Keating
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  5. S Pierce
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  6. G Garcia-Manero
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Correspondence to A-M Tsimberidou.

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Tsimberidou, AM., Estey, E., Kantarjian, H. et al. Granulocyte colony stimulating factor administration associated with cerebral hemorrhage in acute promyelocytic leukemia. Leukemia 20, 1452–1453 (2006). https://doi.org/10.1038/sj.leu.2404272

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