RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS ASSOCIATED NEUTROPENIA AND REFRACTORYINFECTIONS

Objective, To investigate whether human recombinant granulocyte colony stimulating factor (GCSF) is capable of inducing increased neutrophil granulocyte (polymorphonuclear leukocytes, PMN) counts in patients wi th systemic lupus erythematosus (SLE) associated neutropenia and refra ctory infections. Methods. Nine patients with SLE associated neutropen ia and concomitant refractory infections received a total of 12 cycles of 48 Mio U GCSF per day subcutaneously for an average of 6 days (ran ge 1-17 days) as an adjunct to antibiotic treatment. In one case of im paired wound healing, longterm GCSF was applied over 148 days. Results , In each case, the average PMN count increased distinctly within 2 da ys 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 pati ents and leukocytoclastic vasculitis in one. Conclusion, GCSF induces a rapid increase in PMN counts in patients with lupus associated neutr openia and normal or hyperplastic granulopoiesis. In 3 of 9 patients w e observed a flare of lupus associated symptoms.