Aplastic anemia frequently presents with pancytopenia, cinluding severe neutropenia and ti is tempting to use G-CSF to attempt tor aise white counts. However, there are only observatonsal and restrospective studies supporting this practice. There are also reports of acute leukemia, especially with the monosmy 7, developing after G-CSF use in Aplastic Anemia.
The calculation of risk-benefit is different when there is severe neutropenic infection. In this situation, the guideline by March et al says: “A short course of granulocyte colony-stimulating factor (G-CSF) may be considered for severe systemic infection that is not responding to intravenous antibiotics and anti-fungal drugs, but should be discontinued after 1 week if there is no increase in the neutrophil count. “
Socie G, Mary JY, Schrezenmeier H, et al. Granulocyte-stimulating factor and
severe aplastic anemia: a survey by the European Group for Blood and Marrow
Kaito K, Kobayashi M, Katayama T, et al. Long-term administration of G-CSF
for aplastic anaemia is closely related to the early evolution of monosomy 7
MDS in adults. Br J Haematol. 1998;103:297-303.
Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC, Keidan J, Laurie A, Martin A, Mercieca J, Killick SB, Stewart R, Yin JA, British Committee for Standards in Haematology. Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol 2009 Oct;147(1):43-70. [175 references]