Ll. Schmitz et al., MORPHOLOGIC AND QUANTITATIVE CHANGES IN BLOOD AND MARROW-CELLS FOLLOWING GROWTH-FACTOR THERAPY, American journal of clinical pathology, 101(1), 1994, pp. 67-75
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.