Recombinant human granulocyte colony stimulating factor in patients with systemic lupus erythematosus associated neutropenia and refractory infections.

OBJECTIVE

To investigate whether human recombinant granulocyte colony stimulating factor (GCSF) is capable of inducing increased neutrophil granulocyte (polymorphonuclear leukocytes, PMN) counts in patients with systemic lupus erythematosus (SLE) associated neutropenia and refractory infections.

METHODS

Nine patients with SLE associated neutropenia and concomitant refractory infections received a total of 12 cycles of 48 Mio U GCSF per day subcutaneously for an average of 6 days (range 1-17 days) as an adjunct to antibiotic treatment. In one case of impaired wound healing, longterm GCSF was applied over 148 days.

RESULTS

In each case, the average PMN count increased distinctly within 2 days from 1.3 per nl (range 0.7-2.4) to 8.4/nl (3.2-19.4). Major adverse events were exacerbation of central nervous system symptoms in 2 patients and leukocytoclastic vasculitis in one.

CONCLUSION

GCSF induces a rapid increase in PMN counts in patients with lupus associated neutropenia and normal or hyperplastic granulopoiesis. In 3 of 9 patients we observed a flare of lupus associated symptoms.