Nonchemotherapy drug-induced agranulocytosis in elderly patients: the effects of granulocyte colony-stimulating factor

• Published in: The American journal of medicine Vol. 112; no. 6; p. 460
• Main Authors: Andrès, Emmanuel, Kurtz, Jean Emmanuel, Martin-Hunyadi, Catherine, Kaltenbach, Georges, Alt, Martine, Weber, Jean Christophe, Sibilia, Jean, Schlienger, Jean Louis, Dufour, Patrick, Maloisel, F rédéric
• Format: Journal Article
• Language: English
• Published: United States 15-04-2002
• Subjects: Aged; Aged, 80 and over; Agranulocytosis - chemically induced; Agranulocytosis - drug therapy; Anti-Bacterial Agents - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Antithyroid Agents - adverse effects; Female; France; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - adverse effects; Granulocyte Colony-Stimulating Factor - therapeutic use; Hospitals, University; Humans; Leukocyte Count; Male; Patient Compliance; Patient Selection; Platelet Aggregation Inhibitors - adverse effects; Treatment Outcome; France
• DOI: 10.1016/s0002-9343(02)01064-1
• ISSN: 0002-9343

Elderly patients with nonchemotherapy drug-induced agranulocytosis present commonly with severe infections, and have a mortality of at least 20%. We studied whether granulocyte colony-stimulating factor (G-CSF), a hematopoietic growth factor that shortens the duration of neutropenia, is useful in these patients.
We studied 54 patients > or =65 years of age who had drug-induced agranulocytosis, some of whom had been treated with G-CSF. We determined the times until hematologic recovery (defined as a neutrophil count >1.5 x 10(9)/L), tolerance of G-CSF, and clinical outcomes.
Of the 54 patients, 20 received G-CSF. Two patients who had not been treated with G-CSF died of uncontrolled septic shock and extensive pneumonia. The mean (+/- SD) time until hematologic recovery was significantly less in patients treated with G-CSF (6.6 +/- 3.9 days vs. 8.8 +/- 4.9 days, P <0.04). Compliance with G-CSF therapy was good; only mild flu-like symptoms and transient bone pain were reported in 12 patients.
Our findings suggest that G-CSF therapy may be beneficial in the management of drug-induced agranulocytosis in elderly patients.