TREATMENT OF FELTYS-SYNDROME WITH THE HEMATOPOIETIC GROWTH-FACTOR GRANULOCYTE-COLONY-STIMULATING FACTOR (G-CSF)

Felty's syndrome (FS) (rheumatoid arthritis with neutropenia and splen omegaly) has a poor prognosis, largely because of the high risk of sev ere infection. Granulocyte colony-stimulating factor (G-CSF) is an eme rging treatment for chronic neutropenia. We prospectively monitored it s use in eight patients with recurrent infections or who required join t surgery. Significant side-effects were documented in five, including nausea, malaise, generalized joint pains, and in one patient, a vascu litic skin rash. In two patients treatment had to be stopped, and in t hese cases G-CSF had been started at full vial dosage (300 mu g/ml fil grastim or 263 mu g/ml lenograstim) alternate days or daily. G-CSF tre atment was continued in three patients by restarting at reduced dose, and changing the proprietary formulation. G-CSF raised the neutrophil count, reduced severe infection, and allowed surgery to be performed. A combined clinical and laboratory index suggested that long-term trea tment (up to 3.5 years) did not exacerbate the arthritis. Once on esta blished treatment, it may be possible to use smaller weekly doses of G -CSF to maintain the same clinical benefit. One of the three patients whose FS was associated with a large granular T-cell lymphocytosis sho wed a reduction in this subset of lymphocytes during G-CSF treatment.