Early Trilineage Recovery by Granulocyte Colony-Stimulating Factor in a Patient with Aplastic Anemia

Dr. Yuzuru Kanakura, Second Department of Internal Medicine, Osaka University Medical School, Yamadaoka 2-2, Suita Osaka 565 (Japan) Among the cytokines active in hematopoiesis, granulocyte colony-stimulating factor (G-CSF) has functions mainly on cells of neutrophilic granulocyte lineage [1]. A large number of clinical trials have suggested that G-CSF can accelerate the recovery of neutrophils when used after high-dose cytotoxic chemotherapy or bone marrow transplantation [2, 3]. In addition, G-CSF have been shown to have beneficial effects in patients with aplastic anemia (AA) who suffer from severe neutropenia [4]. With the exception of rare instances, however, G-CSF is known to have little or no effect on erythrocyte or platelet counts [2, 4-7]. We report here a unique case with acquired AA who showed trilineage recovery shortly after administration of rhG-CSF. Case Report A 57-year-old man was referred to Osaka University Hospital because of pancytopenia in April 1993. He had a 3-month history of pancytopenia and had received a total of 800 ml of red blood cell (RBC) in a previous hospital. Laboratory data were as follows: hemoglobin (Hb), 11.2 g/dl (immediately after RBC transfusion); reticulo-cytes88 × 109/1, white blood cells (WBC), 3.2 × 109/1 with differentials of 35% neutrophils and 56% lymphocytes; and platelets (PLT) 73 × 109/1. Bone marrow aspirate and biopsy revealed uniform hypocellularity (nucleated cell count, 14 × 109/l)withnomegakaryo-cytes and no morphological abnormalities. Based on these findings, he was diagnosed as having mild AA [8]. Daily anabolic steroids were thus administered orally at a dose of 30 mg/kg body weight in April 1993. This treatment did not improve the hematologic parameters and hemoglobin decreased (fig. 1). Because RBC transfusions were required every 2 or 4 weeks, the patient was admitted to our hospital on September 21, 1993. Hemoglobin was 8.6 g/dl, reticulocytes 80 × 109/1, WBC 2.71 × 109/1 (47.8% neutrophils, 3.8% eosinophils, 39.9% lymphocytes, 8.1% monocytes), and PLT