Reactions 1166 - 25 Aug 2007 S Granulocyte colony-stimulating factors/ granulocyte-macrophage colony- stimulating factors Splenic rupture: case report A 53-year-old man developed splenic rupture while receiving granulocyte colony-stimulating factors and granulocyte-macrophage colony-stimulating factors for stem cell mobilisation prior to stem cell transplantation. The man had multiple myeloma, chronic renal insufficiency secondary to light chain disease, transfusion-dependent anaemia and coagulopathy. He started receiving granulocyte- macrophage colony-stimulating factors 5 mg/kg/day. Five days later, he was hospitalised with neutropenic fever, hypotension (BP 90/52mm Hg) and worsening renal failure. He received piperacillin/tazobactam, levofloxacin and a dobutamine drip. On the day of admission, he also received a single dose of granulocyte-macrophage colony-stimulating factors [dosage not stated]. On hospital day 2, he started receiving granulocyte colony-stimulating factors 10 µg/kg/day and granulocyte- macrophage colony-stimulating factors were continued at a dose of 5 µg/kg/day. From day 7–10, after initial growth factor administration, leukapheresis was performed. Two days later, he started to report malaise, cough, vague abdominal discomfort and pain that radiated to his left shoulder. His BP was 90/54mm Hg. His WBC count was 19.2 x 10 9 /L (47.9 x 10 9 /L the previous day) and his haemoglobin level was 7.7 g/dL (9.7 g/dL the previous day). The man received two units of packed red blood cells. His haemoglobin level increased to 7.9 g/dL. A noncontrast CT scan of his pelvis and abdomen showed a ruptured/lacerated spleen with haemoperitoneum and pelvic ascites. He underwent an emergency splenectomy and received another four units of packed red blood cells. His spleen weighed 354g and measured 14 x 11.5 x 5.2cm. It had adherent blood clots and multiple subcapsular haematomas, containing clotted blood, on the external surface. He recovered from the splenectomy, and subsequently underwent autologous stem cell transplantation, but later relapsed. He was lost to follow- up, but is believed to have died. Veerappan R, et al. Splenic rupture in a patient with plasma cell myeloma following G-CSF/GM-CSF administration for stem cell transplantation and review of the literature. Bone Marrow Transplantation 40: 361-364, No. 4, Aug 2007 - USA 801091221 1 Reactions 25 Aug 2007 No. 1166 0114-9954/10/1166-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Granulocyte colony-stimulating factors/granulocyte-macrophage colony-stimulating factors

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Page 1: Granulocyte colony-stimulating factors/granulocyte-macrophage colony-stimulating factors

Reactions 1166 - 25 Aug 2007

SGranulocyte colony-stimulating factors/granulocyte-macrophage colony-stimulating factors

Splenic rupture: case reportA 53-year-old man developed splenic rupture while

receiving granulocyte colony-stimulating factors andgranulocyte-macrophage colony-stimulating factors for stemcell mobilisation prior to stem cell transplantation.

The man had multiple myeloma, chronic renal insufficiencysecondary to light chain disease, transfusion-dependentanaemia and coagulopathy. He started receiving granulocyte-macrophage colony-stimulating factors 5 mg/kg/day. Five dayslater, he was hospitalised with neutropenic fever, hypotension(BP 90/52mm Hg) and worsening renal failure. He receivedpiperacillin/tazobactam, levofloxacin and a dobutamine drip.On the day of admission, he also received a single dose ofgranulocyte-macrophage colony-stimulating factors [dosagenot stated]. On hospital day 2, he started receiving granulocytecolony-stimulating factors 10 µg/kg/day and granulocyte-macrophage colony-stimulating factors were continued at adose of 5 µg/kg/day. From day 7–10, after initial growth factoradministration, leukapheresis was performed. Two days later,he started to report malaise, cough, vague abdominaldiscomfort and pain that radiated to his left shoulder. His BPwas 90/54mm Hg. His WBC count was 19.2 x 109/L(47.9 x 109/L the previous day) and his haemoglobin level was7.7 g/dL (9.7 g/dL the previous day).

The man received two units of packed red blood cells. Hishaemoglobin level increased to 7.9 g/dL. A noncontrast CTscan of his pelvis and abdomen showed a ruptured/laceratedspleen with haemoperitoneum and pelvic ascites. Heunderwent an emergency splenectomy and received anotherfour units of packed red blood cells. His spleen weighed 354gand measured 14 x 11.5 x 5.2cm. It had adherent blood clotsand multiple subcapsular haematomas, containing clottedblood, on the external surface. He recovered from thesplenectomy, and subsequently underwent autologous stemcell transplantation, but later relapsed. He was lost to follow-up, but is believed to have died.Veerappan R, et al. Splenic rupture in a patient with plasma cell myelomafollowing G-CSF/GM-CSF administration for stem cell transplantation and reviewof the literature. Bone Marrow Transplantation 40: 361-364, No. 4, Aug 2007 -USA 801091221