Department of Internal Medicine, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima-gun, Gifu, 501-6062, Japan.
Department of Hematology and Oncology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima-gun, Gifu, 501-6062, Japan.
J Infect Chemother. 2024 Feb;30(2):150-153. doi: 10.1016/j.jiac.2023.09.026. Epub 2023 Sep 27.
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease potentially induced by various causes. Very few reports have described HLH induced by granulocyte colony-stimulating factor (G-CSF) and those few previous reports have uniformly indicated that continuing G-CSF is unfeasible once HLH has been induced. A 52-year-old Japanese man who had been diagnosed with mantle cell lymphoma with systemic and central nervous system involvements received rituximab, hyper-fractionated cyclophosphamide, vincristine, Adriamycin and dexamethasone (R-HCVAD)/methotrexate and cytarabine. During the second cycle of R-HCVAD, the patient developed severe back pain, thrombocytopenia, elevated serum lactate dehydrogenase and ferritin levels, and hemophagocytosis in the bone marrow. Complete remission (CR) of mantle cell lymphoma was confirmed on whole-body computed tomography, brain magnetic resonance imaging, and bone marrow biopsy. The patient was diagnosed with HLH induced by filgrastim. HLH recovered with intravenous methylprednisolone at 1 g/day for 3 days, followed by oral prednisolone tapered off over 5 days. The patient continued chemotherapy with a change in the G-CSF formulation from filgrastim to lenograstim and prophylactic administration of corticosteroids. He safely completed scheduled chemotherapy without recurrence of HLH and successfully maintained CR of lymphoma. Although rare, G-CSF potentially induces HLH. Changing the G-CSF formulation and steroid prophylaxis may allow safe continuation of G-CSF.
噬血细胞性淋巴组织细胞增生症（HLH）是一种潜在危及生命的疾病，可能由各种原因引起。极少数文献报道过由粒细胞集落刺激因子（G-CSF）引起的 HLH，而这些少数先前的报告都一致表明，一旦发生 HLH，继续使用 G-CSF 是不可行的。一位 52 岁的日本男性，被诊断为伴有全身和中枢神经系统受累的套细胞淋巴瘤，接受了利妥昔单抗、高剂量环磷酰胺、长春新碱、阿霉素和地塞米松（R-HCVAD）/甲氨蝶呤和阿糖胞苷治疗。在接受第二个 R-HCVAD 周期时，患者出现严重背痛、血小板减少、血清乳酸脱氢酶和铁蛋白水平升高，骨髓中出现噬血细胞现象。全身计算机断层扫描、脑磁共振成像和骨髓活检证实套细胞淋巴瘤完全缓解（CR）。该患者被诊断为因非格司亭引起的 HLH。HLH 经 1 g/天静脉注射甲基强的松龙 3 天恢复，随后口服泼尼松龙 5 天逐渐减量。患者继续接受化疗，将 G-CSF 制剂从非格司亭改为培非格司亭，并预防性给予皮质类固醇。他安全地完成了预定的化疗，没有 HLH 复发，并成功维持了淋巴瘤的 CR。尽管罕见，但 G-CSF 可能会引起 HLH。改变 G-CSF 制剂和类固醇预防可能允许安全地继续使用 G-CSF。
