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Neurological Surgery No Shinkei Geka Volume 22, Issue 2 （February 1994）

Neurological Surgery 脳神経外科 22巻2号（1994年2月発行）

Japanese English

症例

顆粒球コロニー刺激因子投与中に間質性肺炎を併発した神経膠芽腫の1例 A Case Report of Interstitial Pneumonia Caused by Granulocyte Colony-stimulating Factor 伊林至洋 ¹ , 大山浩史 ¹ , 橋本祐治 ¹ , 酒谷薫 ¹ , 森本繁文 ¹ , 高橋弘毅 ² , 柴田和則 ³ , 柏原茂樹 ³ , 田辺純嘉 ¹ , 端和夫 ¹ Yukihiro IBAYASHI ¹ , Hiroshi OHYAMA ¹ , Yuji HASHIMOTO ¹ , Kaoru SAKATANI ¹ , Shigefumi MORIMOTO ¹ , Hiroki TAKAHASHI ² , Kazunori SHIBATA ³ , Shigeki KASHIWABARA ³ , Sumiyoshi TANABE ¹ , Kazuo HASHI ¹ ¹札幌医科大学脳神経外科 ²札幌医科大学第3内科 ³旭川脳神経外科病院 ¹Department of Neurosurgery,Sapporo Medical University,School of Medicine ²Department of Internal Medicine (Section 3) Sapporo Medical University School of Medicine ³Asahikawa Neurosurgical Hospital キーワード： Immunochemoradiotherapy , G-CSF , Glioblastoma multiforme , Interstitial pneumonia , Neutropenia Keyword: Immunochemoradiotherapy , G-CSF , Glioblastoma multiforme , Interstitial pneumonia , Neutropenia pp.169-174

発行日 1994年2月10日 Published Date 1994/2/10

DOI https://doi.org/10.11477/mf.1436900790

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Abstract 文献概要
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I．はじめに

　悪性脳腫瘍に対する同調化学放射線療法や強力な化学療法に伴う好中球減少症に対して，顆粒球コロニー刺激因子（G-CSF）は好中球減少期用の短縮および好中球最低値の上昇などに有効であるとされ^5,6），最近多くの施設で使用されている．しかし，顆粒球マクロファージコロニー刺激因子（GM-CSF）の大量投与例で呼吸不全や胸水・心のう水貯留，血栓症，心外膜炎などの副作用が報告されていること^4,12）から，同じサイトカインのグループであるG-CSFでも副作用としての組織障害や炎症反応の増悪が起こり得ることを十分認識しなければならない．

　今回免疫化学放射線療法中の好中球減少期にG-CSFを投与して，それがきっかけとなったと思われる間質性肺炎を経験したので報告する．

Several clinical trials have demonstrated that gra-nulocyte colony-stimulating factor (G-CSF) accelerates the recovery of neutropenia in chemotherapy-induced bone marrow suppression.

In this report, we describe a 46-year-old female with glioblastoma multiforme who developed interstitial pneumonia due to administration of G-CSF during the phase of immunochemoradiotherapy-induced neutrope-nia. Thirty-three clays after starting immunochemo-radiotherapy (ACNU, VCR, IFN-β, radiation), she de-veloped neutropenia (1,000/μ) . Administration of G-CSE- at closes of 125-250μg/day led to an increase of peripheral neutrophil counts. Eleven clays later, the pa-tient developed sudden severe respiratory failure and cyanosis with worsening of lung shadows. Blood gas levels on room air were P_aO₂ 49.3mmHg, P_aCO₂, 28.0mmHg, and pH 7.46. At this time, her neutrophil count had risen to 26,080/ul. LDH and a - HBD had also increased to 1,439 IU/l and 1,117IU/l respectively. Chest radiograph and CT scan demonstrated interstitial pneumonia. After treatment with methyl prednisolone, her respiratory symptoms were gradually resolved. A number of side-effects have been reported with granulocyte-macrophage colony-stimulating factor (GM-CSF). These include fluid retention with pericar-dial and pleural effusion, fever, hone pain, fatigue, and rash. This report also suggests that G-CSF might be a cause of interstitial pneumonia during the phase of im-munochemoradiotherapy-induced neutropenia.