G-CSF for Autoimmune Neutropenia(AIN) – pro
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.
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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.