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Taimen K, Heino S, Kohonen I, Relas H, Huovinen R, Hänninen A, Pirilä L. Granulocyte colony-stimulating factor- and chemotherapy-induced large-vessel vasculitis: six patient cases and a systematic literature review. Rheumatol Adv Pract 2020; 4:rkaa004. [PMID: 32128475 PMCID: PMC7046168 DOI: 10.1093/rap/rkaa004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Patients receiving chemotherapy are prone to neutropoenic infections, presenting with non-specific symptoms such as a high fever and elevated inflammatory parameters. Large-vessel vasculitis (LVV) may have a similar clinical presentation and should be included in differential diagnostics. A few published case reports and adverse event reports suggest a causal association between LVV and the use of granulocyte colony-stimulating factor (G-CSF) and chemotherapy. Our objective was to evaluate the relationship between LVV, G-CSF and chemotherapy. METHODS Between 2016 and 2018, we identified six patients in Finland with probable drug-induced LVV associated with G-CSF and chemotherapy. All six patients had breast cancer. A systematic literature review was performed according to PRISMA guidelines using comprehensive search terms for cancer, chemotherapy, G-CSF and LVV. RESULTS The literature search identified 18 similar published case reports, of which most were published after 2014. In all patients combined (n = 24), the time delay from the last drug administration to the LVV symptoms was on average 5 days with G-CSF (range = 1-8 days) and 9 days with chemotherapy (range = 1-21 days). Common symptoms were fever (88%), neck pain (50%) and chest pain (42%). Based on imaging, 17/24 (71%) had vascular inflammation in the thoracic aorta and supra-aortic vessels, but 5/24 (21%) reportedly had inflammation limited to the carotid area. CONCLUSION This review suggests that LVV may be a possible serious adverse event associated with G-CSF and chemotherapy. Successful management of drug-induced LVV requires early identification, through diagnostic imaging, and discontinuation of the drug.
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Affiliation(s)
- Kirsi Taimen
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
| | - Samu Heino
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
| | - Ia Kohonen
- Department of Radiology, Turku University Hospital, Turku
| | - Heikki Relas
- Department of Rheumatology, Helsinki University Hospital, Helsinki
| | - Riikka Huovinen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku
| | - Arno Hänninen
- Department of Clinical Microbiology and Immunology, Turku University Hospital, Turku, Finland
| | - Laura Pirilä
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
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Roupie AL, de Boysson H, Thietart S, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Decaux O, d'Aveni M, Rossignol J, Galland J, Solary E, Willems L, Schleinitz N, Ades L, Dellal A, Samson M, Aouba A, Fenaux P, Fain O, Mekinian A. Giant-cell arteritis associated with myelodysplastic syndrome: French multicenter case control study and literature review. Autoimmun Rev 2019; 19:102446. [PMID: 31838164 DOI: 10.1016/j.autrev.2019.102446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) and MDS/myeloproliferative neoplasms (MDS/MPN) can be associated with giant cell arteritis (GCA). In this nationwide study by the "French Network of dysimmune disorders associated with hemopathies" (MINHEMON) the objective was to evaluate characteristics, treatment and outcome of GCA MDS-MDS/MPN. PATIENTS AND METHODS Retrospective analysis of patients that presented a MDS or MDS/MPN associated with GCA. Treatment efficiency, relapse-free and overall survival of GCA MDS-MDS/MPN were compared to GCA alone. RESULTS Twenty-one patients with GCA MDS-MDS/MPN were included with median age 76 [42-92], M/F ratio 2.5, 8 MDS with multilineage dysplasia (38%), 4 chronic myelomonocytic leukemia (19%), at low or intermediate risk according to IPPS and IPSS-R. The prevalence of headaches, jaw claudication and anterior ischemic optic neuropathy was significantly lower in patients with GCA MDS-MDS/MPN compared to idiopathic GCA (14.3%, 0% and 0% versus 30%, 25%, and 25%, respectively; p < .05). Other clinical and histology findings were similar. All GCA patients received steroid therapy as first-line treatment. Complete or partial response was observed in 14 GCA MDS-MDS/MPN patients (66.7%), of whom 6 (28.6%) received combined immunosuppressive therapies (versus 10% of idiopathic GCA; p = .07). Relapse incidence was similar in the two groups. Steroid dependence was more frequent among GCA MDS-MDS/MPN patients (12 (57%) versus 18 (22.5%); p < .05). Relapse-free and steroid-free survivals were significantly decreased in GCA MDS-MDS/MPN patients (log rank 0.002 and 0.049 respectively), but not overall survival. CONCLUSION Characteristics of GCA MDS-MDS/MPN seem different than idiopathic GCA, with a distinct clinical phenotype and poorer outcome with a higher risk of steroid dependence and relapse.
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Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Sara Thietart
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, F75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, CHU Marseille, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Olivier Decaux
- Department of Internal Medicine, CHU Rennes, Rennes, France
| | - Maud d'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805 Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805 Villejuif, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Maxime Samson
- Department of Internal Medicine, CHU Dijon, Dijon, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Pierre Fenaux
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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