Granulocyte Colony Stimulating Factor (G-CSF) Induced Splenic Infarction in Breast Cancer Patient Treated with Dose-Dense Chemotherapy Regimen.

Majed A Alshamrani,Ahmed H Abdulrahim,Meteb Al-Foheidi

doi:10.1155/2019/8174986

Abstract

Introduction Granulocyte colony-stimulating factor (G-CSF) is commonly used for prevention and treatment of febrile neutropenia among solid tumor patients. It is considered an effective and relatively safe supportive care medication; however, it can cause rare and serious side effects such as spleen rupture or infarction. Case Presentation We are reporting a case of a 27-year-old female with breast cancer who has been treated with dose-dense chemotherapy and received colony-stimulating factor as primary prevention of febrile neutropenia that was complicated halfway through with splenic infarction. This finding was confirmed by computed tomography (CT) scan and splenic biopsy. Management was conservative without the need of surgical intervention. Conclusion Although splenic infarction is an extremely rare side effect of G-CSF, it can be a serious complication that should be recognized, monitored, and managed carefully.

Highlights

Granulocyte colony-stimulating factor (G-CSF) is commonly used for prevention and treatment of febrile neutropenia among solid tumor patients
It is considered effective and relatively safe but it carries a risk for causing bone pain and local skin reactions at the site of injection [8]
Prophylactic G-CSF use is recommended when the risk of chemotherapy-induced febrile neutropenia is >20% to maintain both dose density and dose intensity which has a major survival benefit [1, 2]

Summary

Introduction

Febrile neutropenia (FN) is common with chemotherapeutic agents and considered one of the oncologic emergencies [1, 2]. G-CSF can be used as secondary prophylaxis or for the treatment of established neutropenic fever [2, 7] It is considered effective and relatively safe but it carries a risk for causing bone pain and local skin reactions at the site of injection [8]. There were few case reports of severe splenic rupture, splenic infarction, myocardial infarction, and stroke associated with use of colony-stimulating factors in both hematologic and solid tumors. For those who developed splenic complication, some of them were managed conservatively while those having other severe complications warranted splenectomy [9,10,11,12]

Case Report

Discussion

Findings

Conflicts of Interest