| Abstract | Felty's syndrome (FS) (rheumatoid arthritis with neutropenia and splenomegaly) has a poor prognosis, largely because of the high risk of severe infection. Granulocyte colony-stimulating factor (G-CSF) is an emerging treatment for chronic neutropenia. We prospectively monitored its use in eight patients with recurrent infections or who required joint surgery. Significant side-effects were documented in five, including nausea, malaise, generalized joint pains, and in one patient, a vasculitic skin rash. In two patients treatment had to be stopped, and in these cases G-CSF had been started at full vial dosage (300 micrograms/ml filgrastim or 263 micrograms/ml lenograstim) alternate days or daily. G-CSF treatment 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 treatment (up to 3.5 years) did not exacerbate the arthritis. Once on established 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 showed a reduction in this subset of lymphocytes during G-CSF treatment. |
| Authors | S J Stanworth, M Bhavnani, C Chattopadhya, H Miller, D R Swinson
(Affiliation: Department of Haematology, Manchester Royal Infirmary.)
|
| Journal | QJM : monthly journal of the Association of Physicians
(QJM)
Vol. 91
Issue 1
Pg. 49-56
(Jan 1998)
ISSN: 1460-2725 ENGLAND |
| PMID | 9519212
(Publication Type: Clinical Trial, Journal Article)
|
| Chemical References |
- Adjuvants, Immunologic
- Recombinant Proteins
- Filgrastim
- lenograstim
- Granulocyte Colony-Stimulating Factor
|
| Topics |
- Adjuvants, Immunologic
(adverse effects, therapeutic use)
- Aged
- CD8-Positive T-Lymphocytes
- Drug Administration Schedule
- Felty's Syndrome
(drug therapy, immunology)
- Female
- Filgrastim
(adverse effects, therapeutic use)
- Granulocyte Colony-Stimulating Factor
(adverse effects, therapeutic use)
- Humans
- Leukocyte Count
- Male
- Middle Aged
- Platelet Count
- Prospective Studies
- Recombinant Proteins
(adverse effects, therapeutic use)
|
