We have a male patient of 5 yrs old suffering from ALL receiving chemo UK ALL-2003 modified protocol delayed intensification.During this period he suffered severe neutropenia for 7 days, At that time he received proper dose of filgrastim for three days. After 3 days his CBC reveals increased number of neutrophil and blast. I like to know any role of filgrastim and blast production.
of course there is transient increases in bone marrow and peripheral blood blast cell as the effect of G-CSF therapy.
Transient increase in blasts mimicking acute leukemia and progressing myelodysplasia in patients receiving growth factor.
Thank you for your comment.
The G-CSF-receptor is present on precursor cells in the bone marrow, and, in response to stimulation by G-CSF, initiates proliferation and differentiation into mature granulocytes. G-CSF stimulates the survival, proliferation, differentiation, and function of neutrophil precursors and mature neutrophils.But this patient CBC reveals blast like lymphoblast. Bonemarrow and immunophenotyping result pending. But my question it is relapse or G-CSF induced.
Filgrastim is recommeded for use in neutropenic conditions. It is a recombinant Granulocyte colony stimulating factor ( G CSF) and stimulates marrow to produce more granulocytes. When you administer G CSF, there is a surge of marrow precurosors in to the peripheral blood. in fact, Filgrastim is also used to increase the number of hematopoietic stem cells in the blood before collection by leukapheresis for use in hematopoietic stem cell transplantation. So you need not worry after you see few blasts in the peripheral blood after you administer G CSF. Just that you have to inform the pathologist that you have administered G CSF recently
G-CSF stimulates neutrofilp Production, therefore it should not induce lymphoblasts ( at least I believe so)
do you have an increase number of myeloid blasts or lymphoblasts With the same fenotype as the diaagnosis???
We have seen the Bone marrow today. That reveals Remission. So we believe that it may due to transient rise of blasts in PBF.
Thank you everybody for giving valuable opinion.
yes it increases myeloblast , it has no thing to do with lymphoblast
it is not recommended to be given in ALL
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