MORPHOLOGIC AND QUANTITATIVE CHANGES IN BLOOD AND MARROW-CELLS FOLLOWING GROWTH-FACTOR THERAPY

Sequential blood and bone marrow specimens from 53 patients receiving recombinant granulocyte (G-CSF) or granulocyte macrophage colony stimu lating growth factor (GM-CSF) for neutropenia were evaluated. The bloo d findings were marked by a neutrophilia with a prominent left shift, increased azurophilic granulation, Dohle bodies, and an elevated leuko cyte alkaline phosphatase; circulating myeloblasts were observed but d id not exceed 2% of the leukocytes. Nuclear segmentation abnormalities consisting of hyposegmentation, hypersegmentation, and ring nuclei we re noted but were not a prominent finding. A leukoerythroblastosis was present in 54% of patients. No consistent effect on cell lines other than neutrophils was found. A monocytosis was present in 12 patients, a transient lymphocytosis in 2 and an eosinophilia in 1. No effect was evident on basophils. The morphologic changes in the neutrophils in t he bone marrow specimens were most pronounced in the early period of g rowth factor therapy with a relative neutrophil hyperplasia with a mar ked increase in promyelocytes and myelocytes. With increasing duration of therapy, the myeloid to erythroid ratio normalized and the percent age of promyelocytes decreased while myelocytes and band neutrophils i ncreased. Thirteen patients had no response to growth factor. The nonr esponding patients were clinically diverse; all bone marrow biopsy spe cimens in this group were virtually acellular. No differences were not ed between G-CSF and GMCSF.