[Indications of G-CSF in patients with drug-induced agranulocytosis]

Bone marrow findings at the onset of disease were analyzed in five patients with drug-induced agranulocytosis to detect simple indices for a determination of the indications G-CSF therapy. Two patients showed severe marrow hypoplasia, extremely low ME ratio and complete absence of myelocytes or more mature neutrophils in their bone marrow. In these cases, the periods for recovery to 500 or more peripheral neutrophils per microliter were 5 and 9 days in a G-CSF-treated patient and a non-treated patient, respectively. On the other hand, the bone marrow of other three patients revealed normal or slightly high cellularity, moderately low ME ratio and appearance of myelocytes and more mature neutrophils. In the latter cases, the periods for recovery to 500 or more peripheral neutrophils were 3 days in all cases, regardless of whether G-CSF was administered or not. These findings suggest that G-CSF should be administered to drug-induced agranulocytic patients with severe marrow hypoplasia, extremely low ME ratio and absence of marrow neutrophilic cells.