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Complete remission in hypoplastic acute myeloid leukemia induced by G-CSF without chemotherapy: report on three cases

Leukemia volume 16, pages 1871–1873 (2002)Cite this article

Hematopoietic growth factors (HGF), particularly G-CSF, are widely used in hematopoietic malignancies to reduce the duration of neutropenia induced by chemotherapy and its subsequent infectious complications. In acute myeloid leukemia (AML), G-CSF or GM-CSF has been used to reduce the duration of neutropenia after induction or consolidation therapy. The benefit of such strategies remains controversial: most studies report a shorter duration of neutropenia with a lower incidence of infections in the HGF arms, but no evidence of reduced mortality.1 When HGF is administered concomitantly with chemotherapy, it recycles leukemic cells and may increase their chemosensitivity. In some studies, patients treated with G-CSF or GM-CSF showed a statistically higher rate of complete remission with improvement of DFS but not overall survival.1,2 These studies demonstrate that G-CSF or GM-CSF may have an anti-leukemic effect. In fact, leukemic cells display HGF receptors and some authors have shown G-CSF-induced apoptosis of leukemic cell.3 Comorbid affections due to advanced age or life-threatening infections associated with leukemia can sometimes postpone chemotherapy. Hematopoietic growth factors may be used to temporarily increase the polymorphonuclear neutrophil (PMN) count in cases of severe infection. Recently, spontaneous complete remission of AML has been reported after treatment with G-CSF alone without chemotherapy.4 In all cases patients had concomitant infections except one case reported by Ferrara et al.5 We report on three AML patients without infections who entered CR after initial treatment with G-CSF alone. Cytogenetic remission was documented in one case.

Case 1: A 68-year-old woman was admitted for pancytopenia in March 2000. She presented with ulceronecrotic pharyngitis and fever. Physical examination was normal. Blood count on diagnosis showed: WBC 0.5 × 109/l (PMN: 10%, lymphocytes: 90%), no circulating blast cells, Hb 3.5 g/dl, platelets 62 × 109 /l. Bone marrow examination revealed hypocellular marrow with 30% of blast cells, expressing MPO and CD33, CD13, CD34 antigens. Acute myeloid leukemia (AML-M2) was diagnosed. Karyotype revealed 46XX del 7q11, del 13q in 14 mitoses and a normal pattern in 12 mitoses. Due to severe neutropenia associated with marrow hypoplasia without blastic proliferation, it was decided to treat with G-CSF alone. Lenograstime rhuG-CSF 263 μg (Granocyte 34; Chugai Pharma, France) was administered subcutaneously daily. Two weeks later, WBC increased to 1.6 × 109/l with 60% PMN, Hb 10 g/dl, no circulating blast cells, platelets 90 × 109/l. G-CSF was continued at a dose of 105 μg (Granocyte 13) three times a week. Six weeks after starting therapy, blood count showed: 9.3 × 109/l (PMN: 90%, lymphocytes: 10%), Hb 10 g/dl, platelets 261 × 109/l, and no circulating blast cells. Bone marrow examination was normocellular with less than 5% blast cells. The cytogenetic analysis was normalized with disappearance of the abnormal clone. The patient had achieved complete remission with G-CSF alone and died from relapse.

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Authors and Affiliations

  1. Service d'Hématologie Clinique, CHU de Rennes, France

    S Nimubona, I Grulois, M Bernard & T Lamy

  2. Unité d'Onco-Hématologie, CH de Saint-Malo, France

    I Grulois

  3. Laboratoire d'Hématologie, CHU de Rennes, France

    B Drénou, M Godard & R Fauchet

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Nimubona, S., Grulois, I., Bernard, M. et al. Complete remission in hypoplastic acute myeloid leukemia induced by G-CSF without chemotherapy: report on three cases. Leukemia 16, 1871–1873 (2002). https://doi.org/10.1038/sj.leu.2402592

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