Department of Medical Oncology, 64060Atatürk University Faculty of Medicine, Erzurum, Turkey.
J Oncol Pharm Pract. 2022 Dec;28(8):1902-1905. doi: 10.1177/10781552221082645. Epub 2022 Feb 24.
Granulocyte colony-stimulating factors (G-CSF) are utilized both in the treatment and prophylaxis of chemotherapy-induced neutropenia. Lipegfilgrastim is a long-acting G-CSF. Albeit it provides ease of administration compared to short-acting GCSFs, some lipegfilgrastim-related adverse events may occur. Bone pain, widespread body pain, and feeling of fever are among common adverse effects, while rare but more serious adverse effects such as leukocytosis, spleen rupture, interstitial pneumonia, acute respiratory distress syndrome, capillary leak syndrome, hypokalemia, and glomerulonephritis may occur as well.
We reported a case of hyperleukocytosis that developed due to prophylactic administration of lipegfilgrastim following the first course of neoadjuvant pertuzumab (840-420 mg), trastuzumab (8-6mg/kg), and docetaxel (75 mg/m2) in a 45-year-old female patient with a diagnosis of breast invasive ductal carcinoma. The patient, who presented with weakness, loss of appetite, and oral intake disorder, had elevated white blood cell (WBC), lactate dehydrogenase (LDH), and uric acid levels in her test results. Peripheral smear (PS) had a left shift.
Intravenous 0.9% NaCl and peroral allopurinol were started to be administered to the patient. On the ninth day of hospitalization, the patient's clinical manifestation improved, and her WBC, LDH, uric acid, and PS returned to normal. Besides, the progression to tumor lysis syndrome (TLS) was prevented by appropriate hydration and allopurinol treatment. In subsequent chemotherapies (CTs), lipegfilgrastim was discontinued and filgrastim was started. The patient whose hyperleukocytosis did not recur was operated on following neoadjuvant CT. The patient's routine follow-up continues without any problems.
Although lipegfilgrastim-induced hyperleukocytosis has not been reported in the literature, it should be borne in mind that hyperleukocytosis and related complications may occur, as in our case.
粒细胞集落刺激因子（G-CSF）既用于化疗引起的中性粒细胞减少症的治疗，也用于预防。培非格司亭是一种长效 G-CSF。虽然与短效 GCSF 相比，它的给药更为方便，但也可能会发生一些与培非格司亭相关的不良反应。骨痛、全身广泛疼痛和发热感是常见的不良反应，而白细胞增多症、脾破裂、间质性肺炎、急性呼吸窘迫综合征、毛细血管渗漏综合征、低钾血症和肾小球肾炎等罕见但更严重的不良反应也可能发生。
我们报告了一例 45 岁女性乳腺癌患者在接受新辅助治疗（曲妥珠单抗[840-420mg]、帕妥珠单抗[8-6mg/kg]和多西他赛[75mg/m2]）的第一周期后预防性使用培非格司亭引起的高白细胞血症。该患者表现为虚弱、食欲不振和口腔摄入障碍，其检查结果显示白细胞（WBC）、乳酸脱氢酶（LDH）和尿酸水平升高。外周血涂片（PS）显示左移。
给予患者静脉滴注 0.9%氯化钠和口服别嘌醇。住院第 9 天，患者的临床症状改善，WBC、LDH、尿酸和 PS 恢复正常。此外，通过适当的水化和别嘌醇治疗，预防了肿瘤溶解综合征（TLS）的进展。在随后的化疗（CT）中，停用了培非格司亭，改用粒细胞集落刺激因子。该患者在新辅助 CT 后接受了手术，此后未再出现高白细胞血症。患者的常规随访无异常。
虽然文献中尚未报道培非格司亭引起的高白细胞血症，但应注意，与我们的病例一样，可能会发生高白细胞血症和相关并发症。
