Annals of Hematology

, Volume 65, Issue 5, pp 232–235 | Cite as

Treatment of neutropenia in Felty's syndrome with granulocyte-macrophage colony-stimulating factor — hematological response accompanied by pulmonary complications with lethal outcome

  • A. -R. Gari-Bai
  • C. Rochlitz
  • M. Riewald
  • J. Oertel
  • D. Huhn
Case Report


We report on a 67-year-old man with Felty's syndrome (FS) complicated by recurrent pneumonia and an infected wound, which was not healing in spite of maximal antibiotic and local therapy. Encouraged by previous experience, we treated him with granulocyte-macrophage colony-stimulating factor (GM-CSF). His total leukocyte count rose, but the patient's pneumonia deteriorated. In addition, a previously known chronic obstructive lung disease (COLD) was exacerbated acutely. These complications finally led to his death. Postmortem examination revealed widespread pneumonia with invasive aspergillosis and a peripheral adenocarcinoma in his left lung.

Key words

Neutropenia Felty's syndrome Pulmonary complication GM-CSF 


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  1. 1.
    Addison IE, Johnson B, Deverreux S, et al. (1989) GM-CSF may inhibit neutrophil migration in vivo. Clin Exp Immunol 76: 149–153Google Scholar
  2. 2.
    Antman KH (1990) G-CSF and GM-CSF in clinical trials. Yale J Biol Med 63: 387–410Google Scholar
  3. 3.
    Arning M, Klicle KO, Schneider W (1991) GM-CSF therapy and capillary leak syndrome. Ann Hemat 62: 83Google Scholar
  4. 4.
    Baldwin GC, Gasson JC, Kaufmann SE, et al. (1989) Non-hematopoietic tumor cells express functional M-CSF receptors. Blood 73: 1033Google Scholar
  5. 5.
    Biesma B, Varies EGE de, Willemse PHB, et al. (1990) Efficacy and tolerability of recombinant human GM-CSF in patients with chemotherapy-related leukopenia and fever. Eur J Cancer 26: 932–936Google Scholar
  6. 6.
    Cebon JS, Morstyn G (1990) The potential role of GM-CSF in cancer chemotherapy. Cancer Surv 9: 131–155Google Scholar
  7. 7.
    Champlin RE, Nimer SD, Ireland P, et al. (1989) Treatment of refractory aplastic anemia with recombinant human GM-CSF. Blood 73: 694–699Google Scholar
  8. 8.
    Emminger W, Emminger-Schmidmeier W, Peters C, et al. (1990) Capillary leak syndrome during low-dose GM-CSF treatment of a patient in a continuous febrile state. Blut 61: 219–221Google Scholar
  9. 9.
    Golde DW (1990) Overview of myeloid growth factors. Semin Hematol 27 [Suppl 3]: 1–7Google Scholar
  10. 10.
    Hazenberg BPC, Van Leeuwen MA, Van Rijswijk MH, et al. (1989) Correction of granulocytopenia in Felty's syndrome by GM-CSF. Simultaneous induction of interleukin-6 release and flare up of the rheumatoid arthritis. Blood 74: 2769–2773Google Scholar
  11. 11.
    Hoffken K, Overkamp F, Stirbu J, et al. (1990) recombinant human GM-CSF and low-dose cytosine-arabinoside in the treatment of patients with myelodysplastic syndromes. A phase-II study Onkologie 13: 33–37Google Scholar
  12. 12.
    Joseph G, Neustadt DH, Hamm J, et al. (1991) GM-CSF in the treatment of Felty's syndrome. Am J Hematol 37: 55–56Google Scholar
  13. 13.
    Kaczmarski RS, Mufti GJ (1990) Hypoalbuminaemia after prolonged treatment with recombinant granulocyte-macrophage colony-stimulating factor. Br Med J 301: 1312–1313Google Scholar
  14. 14.
    Lieschke G, Cebon J, Morstyn G (1989) Characterization of the clinical effects after the first dose of GM-CSF. Blood 74: 2634–2643Google Scholar
  15. 15.
    Lubbe AS, Schwella N, Riess H, et al. (1990) Improvement of pneumonia and arthritis in Felty's syndrome by treatment with GM-CSF. Blut 61: 379–380Google Scholar
  16. 16.
    Markusse HM, Breedveld FC, Fibbe WE, et al. (1990) GM-CSF treatment of neutropenia associated with Felty's syndrome. Arthritis Rheum 3: 1865–1867Google Scholar
  17. 17.
    Nemunaitis J, Rabinowe S, Singer J, et al. (1991) Recombinant GM-CSF after autologous bone marrow transplantation for lymphoid cancer. N Engl J Med 324: 1773–1778Google Scholar
  18. 18.
    Philips N, Jacobs S, Stoller R, et al. (1989) Effect of recombinant human GM-CSF on myelopoiesis in patient with refractory metastatic carcinoma. Blood 74: 26–34Google Scholar
  19. 19.
    Powles R, Smith C, Milan S, et al. (1990) Human recombinant GM-CSF in allogenic bone marrow transplantation for leukaemia: double-blind placebo-controlled trial. Lancet 336: 1417–1420Google Scholar
  20. 20.
    Robinson BE, Quesenberry PJ (1990) Hemopoietic growth factors: overview and clinical applications, part I. Am J Med Sci 300: 163–170Google Scholar
  21. 21.
    Robinson BE, Quesenberry PJ (1990) Hemopoietic growth factors: overview and clinical applications, part II. Am J Med Sci 300: 237–244Google Scholar
  22. 22.
    Robinson BE, Quesenberry PJ (1990) Hemopoietic growth factors: overview and clinical applications, part III. Am J Med Sci 300: 311–321Google Scholar
  23. 23.
    Sisson SD, Dinarello CA (1988) Production of interleukin-1B and tumor necrosis factor by human mononuclear cells stimulated with GM-CSF. Blood 72: 1368–1374Google Scholar
  24. 24.
    Steward WP, Scarfee JH, Austin R, et al. (1989) recombinant human GM-CSF given as daily short infusions. A phase-I dose-toxicity study. Br J Cancer 59: 142–145Google Scholar
  25. 25.
    Steward WP, Thatcher N, Kaye SB (1990) Clinical applications of myeloid colony-stimulating factors. Cancer Treat Rev 17: 77–78Google Scholar
  26. 26.
    Thomassen MJ, Muzaffar A, Barna BP, et al. (1991) Induction of cytokine in RNA and secretion in alveolar macrophages and blood monocytes from patients with lung cancer receiving GM-CSF therapy. Cancer Res 51: 857–862Google Scholar
  27. 27.
    Thompson JA, Lee DJ, Kidd P, et al. (1989) Subcutanous GM-CSF in patients with myelodysplastic syndrome: toxicity, pharmacokinetics, and hematological effects. J Clin Oncol 7: 629–637Google Scholar
  28. 28.
    Varies EGE de, Biesma B, Willemse PHB, et al. (1991) A double-blind chemotherapy for ovarian carcinoma. Cancer Res 51: 116–122Google Scholar
  29. 29.
    Verhoef G, Boogaerts M (1991) Treatment with GM-CSF and adult respiratory distress syndrome. Am J Hematol 36: 285–287Google Scholar
  30. 30.
    Weisbart RH, Gasson JC, Golde DW (1989) Colony-stimulating factors and host defence. Ann Intern Med 110: 297–303Google Scholar
  31. 31.
    Wing EJ, Mitchell-Magee D, Whiteside TL, et al. (1989) Recombinant human GM-CSF enhances monocyte cytotoxicity and secretion of human necrosis factor-a and interferon in cancer patients. Blood 73: 643–646Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • A. -R. Gari-Bai
    • 1
  • C. Rochlitz
    • 1
  • M. Riewald
    • 1
  • J. Oertel
    • 1
  • D. Huhn
    • 1
  1. 1.Department of Internal Medicine, Division of Hematology/OncologyFree University of BerlinBerlin 19Germany

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