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Neutrophil dysplasia (acquired pseudo-pelger anomaly) caused by ganciclovir

Anne B Taegtmeyer1, Ozay Halil, Alex D Bell

  • 1Department of Transplant Medicine, Harefield Hospital, Harefield, Middlesex, UK.

Transplantation
|July 9, 2005
PubMed

Insights

Ganciclovir and valganciclovir can cause neutrophil abnormalities in transplant patients with cytomegalovirus infection. These changes, preceding neutropenia, resolved after drug discontinuation, suggesting DNA polymerization interference.

Area of Science:

  • Virology
  • Hematology
  • Pharmacology

Background:

  • Cytomegalovirus (CMV) infection is a significant concern in organ transplant recipients.
  • Antiviral therapies like ganciclovir and valganciclovir are crucial for managing CMV.
  • Neutropenia is a known potential side effect of these antiviral agents.

Observation:

  • Two thoracic organ-transplant recipients with persistent CMV infection were treated with ganciclovir or valganciclovir.
  • Morphologic abnormalities were observed in the circulating neutrophils of both patients.
  • These changes occurred prior to the development of neutropenia and bone marrow hypoplasia.

Findings:

  • The neutrophil morphologic abnormalities likely resulted from interference with DNA polymerization in bone marrow progenitor cells.
  • The observed changes were specifically linked to ganciclovir or valganciclovir treatment.
  • Concomitant use of mycophenolate mofetil or azathioprine was not a factor in these cases.

Implications:

  • Early identification of these neutrophil morphologic changes may serve as a potential biomarker for antiviral drug toxicity.
  • Understanding this mechanism can inform clinical monitoring and management of transplant patients on ganciclovir or valganciclovir.
  • Complete resolution of abnormalities upon drug withdrawal highlights the reversible nature of this adverse effect.

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