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Splenic rupture following administration of pegfilgrastim in a patient with multiple myeloma undergoing autologous peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 38, pages 69–70 (2006)Cite this article

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Spontaneous rupture of the spleen is a rare but serious and life-threatening complication of treatment with granulocyte colony-stimulating factor (G-CSF). A few case reports address the occurrence of splenic rupture after filgrastim therapy, mostly in healthy donors of peripheral blood stem cells, but also in patients with acute myelogenous leukemia, myelodysplastic syndrome and amyloidosis.1, 2, 3, 4, 5 A recent article by Arshad et al.6 describes a case of splenic rupture in a patient with myelodysplastic syndrome following administration of pegfilgrastim. The compound has recently been approved to shorten neutropenia and decrease the incidence of infection in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs. We report a case of splenic rupture in a completely different clinical situation after the use of pegfilgrastim in a patient with multiple myeloma undergoing autologous peripheral blood stem cell transplantation (PBSCT).

A 43-year-old woman was diagnosed with multiple myeloma. At presentation, free κ light chain was identified in the patient's serum, and urine immunofixation electrophoresis showed bence-jones-proteinuria. A bone-marrow biopsy showed 90% plasma cells and a normal karyotype. She had osteolytic lesions of both humeri and femora, anemia (hemoglobin 9.8 g/dl) and mild thrombocytopenia (138.000/μl). No lymphadenopathy or hepatosplenomegaly were evident at the time of diagnosis. Spleen size, determined by ultrasonography, was 11.6 × 4.2 cm. The patient was initially treated with three cycles idarubicin and dexamethasone. For stem cell mobilization, she received 6 mg pegfilgrastim on day 5 after the administration of cyclophosphamide (4 g/m2). This treatment was well tolerated, induced a partial remission and led to successful collection of stem cells.

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Authors and Affiliations

  1. Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Dusseldorf, Germany

    A Kuendgen, R Fenk, I Bruns, M Dommach, A Hünerlitürkoglu, R Haas & G Kobbe

  2. Department of General and Visceral Surgery, Heinrich-Heine-University, Dusseldorf, Germany

    A Schutte

  3. Institute of Pathology, Heinrich-Heine-University, Dusseldorf, Germany

    R Engers

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  1. A Kuendgen
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  2. R Fenk
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Correspondence to A Kuendgen.

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Kuendgen, A., Fenk, R., Bruns, I. et al. Splenic rupture following administration of pegfilgrastim in a patient with multiple myeloma undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 38, 69–70 (2006). https://doi.org/10.1038/sj.bmt.1705382

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