Not all neutropenia as needs to be treated. Especially, when neutropenia is chronic and there are no chronic or recurrent infections, it becomes difficult to advocate for indefinite treatment with G-CSF. Early case reports suggested that G-CSF can modulate autoimmune processes in autoimmune neutropenia(AIN) but that has not been proven. The issue is complicated by the fact that autoimmune neutropenia can be seen in a variety of conditions including felt his syndrome and SLE(Lupus). Different diseases may behave differently. G-CSF is at present reasonable during the first-line therapy for primary AIN to achieve remission of neutropenia. Severe or unresponsive secondary AIN may be treated with G-CSF to increase neutrophil counts and reduce the risk for infection. However, in patients with Felty’s syndrome or SLE, the potential for flare-up of rheumatic disease means that judicious use of the growth factor is required. Although not prospectively studied, the consensus of opinion appears that a trial of G-CSF in AIN and is appropriate. A 2012 textbook recommends attempting to discontinue G-CSF in patients with autoimmune neutropenia after a trial of therapy by decreasing the dose by 50% at the time.
Autoimmune phenomena, a case history British Journal of Haematology Volume 94, Issue 3, pages 464–469, September 1996
Twenty Years of G-CSF: Clinical and Nonclinical Discoveries By Graham Molineux, MaryAnn Foote, Springer 2012, p. 288
Franco Capsoni, Piercarlo Sarzi-Puttini, Alberto Zanella Primary and secondary autoimmune neutropenia Arthritis Res Ther. 2005; 7(5): 208–214.
Newman KA, Akhtari M. Management of autoimmune neutropenia in Felty’s syndrome and systemic lupus erythematosus. Autoimmun Rev. 2011 May; 10(7):432-7.
Sarp U, Ataman S. A benefiicial long-term and consistent response to rituximab in the treatment of refractory neutropenia and arthritis in a patient with Felty syndrome. J Clin Rheumatol. October, 2014. 207:398.