TREATMENT OF CHRONIC NEUTROPENIA ASSOCIATED WITH LARGE GRANULAR LYMPHOCYTOSIS WITH CYCLOSPORINE-A AND FILGRASTIM

A patient with neutropenia and life-threatening infections secondary t o T-gamma lymphoproliferative disease, who did not respond to treatmen t with recombinant human G-CSF (filgrastim), was treated with filgrast im plus cyclosporine A (CyA), The patient achieved a good response in the absolute neutrophil count and subsequently required a dose reducti on in the filgrastim, The patient was eventually discontinued from the CyA but continues on filgrastim alone. While on therapy, the large gr anular lymphocytes disappeared from the circulation and the beta-TCR r earrangement, which was present prior to beginning therapy, became und etectable, The patient had no significant toxicity to the CyA or the f ilgrastim and he has not experienced any serious infections or require d hospitalization. Filgrastim has proven to be relatively nontoxic and of some benefit to patients with this disease and should probably be utilized first when treatment is necessary, However, if improvement is not observed, these findings suggest that a trial of the combination of CyA plus filgrastim may be beneficial. (C) 1995 Wiley-Liss, Inc.