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Analysis of risk factors for myelodysplasias, leukemias and death from infection among patients with congenital neutropenia. Experience of the French Severe Chronic Neutropenia Study Group.

2005; National Institutes of Health; Volume: 90; Issue: 1 Linguagem: Inglês

Jean Donadieu, Thierry Leblanc, Brigitte Bader‐Meunier, Mohamed Barkaoui, Odile Fenneteau, Yves Bertrand, Micheline Maïer-Redelsperger, M. Micheau, Jean Louis Stéphan, N. Phillipe, Pierre Bordigoni, A Babin-Boilletot, Philippe Bensaïd, Anne Marie Manel, E Vilmer, Isabelle Thuret, Stéphane Blanche, Éliane Gluckman, Alain Fischer, Françoise Méchinaud, Bertrand Joly, Thierry Lamy, Olivier Hermine, Bruno Cassinat, Christine Bellanné‐Chantelot, Christine Chomienne,

Erythrocyte Function and Pathophysiology

The two main complications of severe chronic neutropenia are fatal sepsis and myelodysplasia/acute leukemia (MDS/AL). Granulocyte colony-stimulating factor (G-CSF) therapy has significantly reduced the frequency and severity of infections, but its possible influence on the risk of malignancy is not known.The French Severe Chronic Neutropenia (SCN) Registry has prospectively collected data since 1994 on 231 patients with various forms of SCN, namely severe congenital neutropenia (n=101), cyclic neutropenia (n=60), glycogen storage disease type Ib (GSDIb) (n=15) and Shwachman-Diamond syndrome (SDS)(n=55). The median overall follow-up is 11.1 years. Parameters of exposure to G-CSF therapy, such as the time averaged dose, follow up after first use of G-CSF, and the cumulative dose, have been recorded.Eight septic deaths occurred, of which 6 among patients with severe congenital neutropenia and 2 in patients with cyclic neutropenia; none of these 8 patients was receiving G-CSF therapy. No septic deaths occurred during G-CSF therapy. Thirteen cases of MDS/AL were recorded. The cumulative incidence of MDS/AL was 2.7% (SD 1.3%) at 10 years and 8.1% (SD 2.7%) at 20 years.Risk factors for MDS/AL were the diagnostic category, the severity of neutropenia, younger age at diagnosis, and strong exposure to G-CSF. MDS/AL only occurred in patients with severe congenital neutropenia and SDS. Owing to their particular susceptibility to infections, patients with severe congenital neutropenia had the strongest exposure to G-CSF; the risk of leukemia increased with the degree of G-CSF exposure in this subgroup.