Abstract
Fatal hematophagic histiocytosis occurred in two patients after they had received granulocyte-macrophage colony-stimulating factor (GM-CSF) in addition to chemotherapy for malignant non-Hodgkin's lymphoma. In one patient GM-CSF promoted the activity of subclinical hematophagic histiocytosis, resulting in severe pancytopenia and multiorgan failure. In the other patient the syndrome that caused persistent bone marrow failure began after the institution of GM-CSF therapy. Exogenous GM-CSF appears to upregulate preexisting hematophagic histiocytosis and may even contribute to its de novo initiation. It is therefore conceivable that endogenous GM-CSF also plays an essential role in the pathogenesis of this syndrome.
Similar content being viewed by others
Abbreviations
- CMV:
-
cytomegalovirus
- G-CSF:
-
granulocyte colony-stimulating factor
- GM-CSF:
-
granulocyte-macrophage colony-stimulating factor
References
Chen BDM, Mueller M, Chou TH (1988) Role of granulocyte/macrophage colony-stimulating factor in the regulation of murine alveolar macrophage proliferation and differentiation. J Immunol 141:139–144
Coleman DL, Chodakewitz JA, Bartiss AH, Mellors JW (1988) Granulocyte macrophage colony stimulating factor enhances selective effector functions of tissue-derived macrophages. Blood 72:573–578
Devries EGE, Willemse PHB, Biesma B, Stern AC, Limburg PC, Velenga E (1991) Flare-up of rheumatoid arthritis during GM-CSF treatment after chemotherapy. Lancet 338:517–518
Dommann SC, Zimmermann D, Hassam S, Odermatt BF, Risti B, Maurer R (1992) T-cell rich B-cell lymphoma associated with hemophagocytic syndrome. Verb Dtsch Ges Pathol 76:122–125
Donatini B, Krupp J, Jones T (1991) Ecogramostin and preexisting autoimmune thyroid disease. Lancet 338:1526–1527
Elliott MJ, Strasser A, Metcalf D (1991) Selective up-regulation of macrophage function in granulocyte-macrophage colony-stimulating factor transgenic mice. J Immunol 47:2957–2963
Heidenreich S, Gong JH, Schmidt A, Nain M, Gemsa D (1989) Macrophage activation by granulocyte/macrophage colony stimulating factor. Priming for enhanced release of tumor necrosis factor-α and prostaglandin E2. J Immunol 143:1198–1205
Herrmann F, Lindemann A, Lange W, Kochling G, Raghavachar A, Schrezenmeier H, Frickhofen N, Mertelsmann RH (1991) Medullary histiocytosis following treatment of severe aplastic anemia with recombinant human interleukin-3 in combination with antilymphocyte globulin, cyclosporin A and methylprednisolone. Ann Hematol 63:229–231
Metcalf D, Begley CG, Williamson DJ, Nice EC, DeLamarter J, Mermod JJ, Thatcher D, Schmidt A (1987) Hemopoietic responses in mice injected with purified recombinant murine GM-CSF. Exp Hematol 15:1–9
Mitsuyasu RT, Golde DW (1989) Clinical role of granulocyte-macrophage stimulating factor. Hematol Oncol Clin North Am 3:411–425
Nathan FE, Besa EC (1992) GM-CSF and accelerated hemolysis. N Engl J Med 326:417
Reiner AP, Spivak JL (1988) Hematophagic histiocytosis. A report of 23 new patients and a review of the literature. Medicine 67:369–388
Risdall RJ, McKenna RW, Nesbit ME, Krivit W, Balfour HH, Simmons RL, Brunning RD (1979) Virus-associated hemophagocytic syndrome. A benign histiocytic proliferation distinct from malignant histiocytosis. Cancer 44:993–1002
Simms HH, Gaither TA, Fries LF, Frank MM (1991) Monokines released during short-term Fc receptor phagocytosis up-regulate polymorphonuclear leukocytes and monocyte-phagocytic function. J Immunol 147:265–272
Author information
Authors and Affiliations
Additional information
Correspondence to: A. Schaffner
Rights and permissions
About this article
Cite this article
Risti, B., Flury, R. & Schaffner, A. Fatal hematophagic histiocytosis after granulocyte-macrophage colony-stimulating factor and chemotherapy for high-grade malignant lymphoma. Clin Investig 72, 457–461 (1994). https://doi.org/10.1007/BF00180521
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00180521