M. Mittelman et al., IS GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR (GM-CSF) SAFE IN MYELODYSPLASTIC SYNDROMES, Haematologia, 26(2), 1994, pp. 111-115
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.