GRANULOCYTE-COLONY-STIMULATING FACTOR (G-CSF) DEPENDENT HEMATOPOIESISWITH MONOSOMY-7 IN A PATIENT WITH SEVERE APLASTIC-ANEMIA AFTER ATG CSA/G-CSF COMBINED THERAPY/

We report a case of secondary myelodysplastic syndrome (MDS) with mono somy 7, which evolved from severe aplastic anemia (SAA) after long-ter m use of granulocyte colony-stimulating factor (G-CSF). A 36 year old female was admitted for detailed examination and treatment of pancytop enia. SAA was diagnosed based on hypoplastic bone marrow and a normal chromosome study. She was treated with anti-thymocyte globulin (ATG), ciclosporin A (CsA) and G-CSF, which resulted in gradual improvement o f not only the myeloid but also the erythroid-megakaryocyte series. Ho wever, bone marrow dysplasia with monosomy 7 was observed after 7 mont hs of a combination therapy of immunosuppressant and G-CSF, which prom pted the discontinuation of G-CSF administration. Thereafter, bone mar row hypoplasia gradually progressed, resulting in a second aplastic cr isis. During this process, the proportion of marrow cells showing mono somy 7 decreased, and the proportion with normal karyotype increased. Re-administration of G-CSF induced a trilineage, though dysplastic, he matological response; but the monosomy 7 positive population increased again. These observations indicated the presence of C-CSF dependent h ematopoiesis associated with monosomy 7 in this patient. Although many G-CSF related MDS/AML cases with this leukemia-specific abnormal kary otype have been reported with emphasis on the harmful effects of G-CSF , G-CSF was useful even after the appearance of monosomy 7 as a means of avoiding life-threatening infection in this patient. (C) 1998 Elsev ier Science Ireland Ltd. All rights reserved.