A Girl with T-Acute Lymphoblastic Leukemia Complicated by Brain Infarction Associated with Receiving G-CSF

Abstract

We report on a 14 year-old girl with T-cell ALL who developed brain infarctions associated with receiving G-CSF. G-CSFs were administered intravenously for 15 days after induction of chemotherapy. When it was found that she had leukocytosis (predominantly neutrophilia) with a leukocyte count of 39.3×10³/μ1, G-CSFs were continued. On the same day, she had a generalized tonic clonic seizure probably caused by her brain infarction. Her brain CT, MRI and single-photon ECT (SPECT) showed figures compatible with transient brain infarctin. One month after the convulsion, she received high-dose Ara-C and G-CSF for three days, when the leukocyte count rose to 2, 800/μl from 300/μl. At that time, her brain CT and SPECT revealed figures of infarction without neurological abnormalities. The repeated figures of SPECT suggested that her infarctions were related to the administration of G-CSF. It is possible that hyperviscosity, caused by rapidly developed neutrophilia induced by G-CSF, caused her brain infarctions. We think that the use of G-CSF during chemother-apy needs to be watched carefully for possible neurological abnormalities.