HEPATIC-INJURY DUE TO G-CSF APPLICATION

Background: Granulocyte-colony-stimulating factors (G-CSF) commonly ar e used in the treatment of head and neck cancer since the simultaneous chemo-radiotherapy was established as a standard treatment in this fi eld. Hepatotoxic complications of this therapy are rare and occur only in 4% of all applications. Case Reports: (1) A 58-year-old man with p anpharyngeal cancer showed signs of pneumonia after tumor debulking by laser resection and simultaneous chemo-radiotherapy. The local diseas e was already regredient after ciprofloxacin when G-CSF (filgrastime) was applicated for treatment of leukopenia, Shortly after initiation o f this therapy a hepatic injury was observed, leading to lethal multio rganic failure after 6 days. (2) A 69-year-old woman with recurrent ca ncer of the salivary glands developed leukopenia due to simultaneous c hemo-radiotherapy. Additional treatment with filgrastime was followed by an isolated increase of transaminases grade 4 (WHO). No sooner than after 3 months they had declined to normal range. Conclusions: The pr esented hepatotoxic reactions are important but very rare events due t o application of hematopoetic growth factors, Nevertheless, these comp ounds remain an important part of modern chemotherapy, but they should be recognized early.