Longitudinal growth retardation in a prepuberal girl with chronic myeloid leukemia on long-term treatment with imatinib

Letters to the Editor cardiac arrest during an episode of hypoglycemia would, in this case, be due to the PAH aggravation after pegylated filgrastim injection.The lesions of the pulmonary arterioles would have worsened, thus explaining the gravity of the hypoglycemic seizures secondary to her metabolic disorders.The sequence of events, together with the unusually severe hyperleukocytosis (her highest lifetime white cell count) in this neutropenic patient after pegylated G-CSF injection, as well as the absence of fever, and the known priming role of G-CSF for PMN, argue for a role of peg filgrastim in the onset of the respiratory distress.In contrast, the rise in CRP, together with the signs of bronchitis before pegylated G-CSF injection, support the first hypothesis.This case must be considered in the light of the known adverse effect profile of pegylated G-CSF.Indeed, there are already several reports of severe adverse effects, including cases resembling that described here.A patient receiving chronic G-CSF therapy developed marked hyperleukocytosis and Sweet vascularitis after a single injection of pegylated filgrastim.8 Pegylated filgrastim withdrawal led to an improvement three weeks after the last injection.In 2 other cases a neutrophil excess was associated with pyoderma gangrenosum 9 and lung disease, 10 with radiological characteristics similar to those found in our patient.In conclusion, even if the link between pegylated filgrastim and our patient's respiratory distress cannot be proved, this drug should only be used with care in patients with pulmonary arterial hypertension, even when stable.