Summary
This case report describes the clinical use of recombinant human interleukin-3 as adjunct to immunosuppressive therapy with antilymphocyte globulin, cyclosporin A, and methylprednisolone for refractory severe aplastic anemia. Hematopoietic response to treatment was moderate and peripheral blood counts (neutrophils, eosinophils, monocytes, reticulocytes) increased only slightly. Unexpectedly, during the time of interleukin-3 administration a substantial bone marrow infiltration by macrophages became detectable, consistent with the diagnosis of medullary histiocytosis, that may have prevented recovery of normal hematopoiesis in this patient. This observation may indicate the need for careful use of interleukin-3 in patients with drug-induced immunodeficiency.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Camitta BM, Thomas ED, Nathan DG, Gale RP, Kopecky KJ, Rappaport JM, Santos G, Gordan Smith EC, Storb R (1979) A prospective study of androgens and bone marrow transplantation for treatment of severe aplastic anemia. Blood 53: 504–510
Cannistra SA, Vellenga E, Groshek P, Rambaldi A, Griffin JD (1988) Human granulocyte-monocyte colony-stimulating factor and interleukin-3 stimulate monocyte cytotoxicity through a tumor necrosis factor-dependent mechanism. Blood 71: 672–678
Champlin R, Ho W, Gale RP (1983) Antilymphocyte globulin treatment in patients with aplastic anemia: a prospective randomized trial. N Engl J Med 308: 113–118
Emerson SG, Yang YC, Clark SC, Long MV (1988) Human recombinant granulocyte-macrophage CSF and interleukin-3 have overlapping but distinct hematopoietic activities. J Clin Invest 82: 1282–1287
Frickhofen N, Kaltwasser JP, Schrezenmeier H, Raghavachar A, Vogt HG, Herrmann F, Freund M, Meusers P, Salama A, Heimpel H (1991) A prospective trial of antilymphocyte globulin and methylprednisolone with or without cyclosporin A for treatment of aplastic anemia. N Engl J Med 324: 1297–1304
Ganser A, Lindemann A, Seipelt G, Ottmann O, Eder M, Falk S, Herrmann F, Kaltwasser JP, Meusers P, Klausmann M, Frisch J, Schulz G, Mertelsmann R, Hoelzer D (1990) Effects of recombinant human interleukin-3 in aplastic anemia. Blood 76: 1287–1293
Gluckman E (1987) Current status of bone marrow transplantation for severe aplastic anemia: a preliminary report from the International Bone Marrow Transplant Registry. Transplant Proc 19: 2597–2604
Herrmann F, Lindemann A, Raghavachar A, Heimpel H, Herrmann F (1990) In vivo recruitment of GM-CSF responsive myelopoietic progenitor cells by interleukin-3 in aplastic anemia. Leukemia 4: 671–672
Komp DM, Lichtmann MA (1990) Inflammatory and malignant histiocytosis. In: Williams WJ, Beutler E, Erslev AJ, Lichtmann MA (eds) Hematology. Mc Graw-Hill, New York, pp 895–902
Marsh JCW, Hows JM, Bryett KA, Al-Hashimi S, Fairhead SM, Gordon-Smith EC (1987) Survival after antilymphocyte globulin therapy for aplastic anemia depends on disease severity. Blood 70: 1046–1052
McGlave PB, Haake R, Miller W, Kim T, Kersey J, Ramsay NK (1987) Therapy of severe aplastic anemia in young adults and children with allogeneic bone marrow transplantation. Blood 70: 1325–1330
Risdal RJ, McKenna RW, Nesbit ME (1979) Virus-associated hemophagocytic syndrome: a benign histiocytic proliferation distinct from malignant histiocytosis. Cancer 44: 993–997
Speck B (1987) Long-term results of ALG versus bone marrow transplantation in the treatment of severe aplastic anemia. Exp Hematol 15: 614–620
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Herrmann, F., Lindemann, A., Lange, W. et al. 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 (1991). https://doi.org/10.1007/BF01703450
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01703450