IS GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (GM-CSF) SAFE IN MYELODYSPLASTIC SYNDROMES

The complication of secondary myelodysplastic syndrome (sMDS) during t he course of multiple myeloma (MM) has been recognized for more than a decade. sMDS occurs years after MM diagnosis, and typically, at sMDS presentation the MM is stable or inactive. We report a 56-year-old pat ient, who developed sMDS 15 years following the diagnosis of IgG-lambd a MM, which had been completely stable for 13 years. However, very soo n after sMDS was diagnosed, the MM relapsed and required combination c hemotherapy. The first cycle of vincristine, adriamycin and dexamethas one (VAD) resulted in severe neutropenia and sepsis, which was treated with antibiotics and recombinant human granulocyte-macrophage colony- stimulating factor(rHuGM-CSF). Two weeks after GM-CSF administration a transformation to acute myeloblastic leukemia was observed. The relat ion between GM-CSF and the leukemic transformation is discussed and th e possible contribution of the cytokine to the stimulation of this com plication is emphasized.