Monocyte and Basophil Counts as Predictors of Neutrophil Count Recovery in Patients with Thiamazole-Induced Agranulocytosis

Abstract

Purpose: Thiamazole (MMI) is frequently used for the treatment of Graves’ disease, but it occasionally induces agranulocytosis at the beginning of the treatment. To date, the predictive factors of recovery from MMI-induced agranulocytosis remain unclear. The primary aim of this study was to evaluate the predictive factor of the recovery time from MMI-induced agranulocytosis.

Method: This was a retrospective cohort study performed in a university hospital and a thyroid hospital. We included 27 Japanese patients with Graves’ disease with MMI-induced agranulocytosis diagnosed during follow-up. All patients were administrated recombinant human granulocyte colony-stimulating factor daily until they had a neutrophil count>1 000/μL, which was defined as recovery. The predictive factors associated with recovery time were estimated using multivariable regression analysis.

Results: At the onset of agranulocytosis, the median administration period of MMI was 33 days, the average white blood cell count was 1 896/μL, and the median neutrophil count was 22/μL. The median recovery time was 4 days. Stepwise multivariate regression analysis identified the monocyte and basophil counts to be significant predictors of MMI-induced agranulocytosis.

Conclusion: Patients with agranulocytosis and decreased monocyte and basophil counts at onset may recover late and require careful treatment.

Key words

thiamazole - agranulocytosis - recovery time - monocyte - basophil

^* Contributed equally to this work.

• References

• 1 Kobayashi S, Noh JY, Mukasa K et al. Characteristics of agranulocytosis as an adverse effect of antithyroid drugs in the second or later course of treatment. Thyroid 2014; 24: 796-801
• 2 Kaufman DW, Kelly JP, Issaragrisil S et al. Relative incidence of agranulocytosis and aplastic anemia. Am J Hematol 2006; 81: 65-67
• 3 Julia A, Olona M, Bueno J et al. Drug-induced agranulocytosis: prognostic factors in a series of 168 episodes. Br J Haematol 1991; 79: 366-371
• 4 Hashino S, Morioka M, Irie T et al. Cost benefit and clinical efficacy of low-dose granulocyte colony-stimulating factor after standard chemotherapy in patients with non-Hodgkin’s lymphoma. Int J Lab Hematol 2008; 30: 292-299
• 5 Kondo K, Oshita F, Kato Y et al. Early monocytopenia after chemotherapy as a risk factor for neutropenia. Am J Clin Oncol 1999; 22: 103-105
• 6 Mullen CA, Buchanan GR. Early hospital discharge of children with cancer treated for fever and neutropenia: identification and management of the low-risk patient. J Clin Oncol 1990; 8: 1998-2004
• 7 Bhatnagar S, Chandra J, Narayan S. Hematological changes and predictors of bone marrow recovery in patients with neutropenic episodes in acute lymphoblastic leukemia. J Trop Pediatr 2002; 48: 200-203
• 8 Heit W, Heimpel H, Fischer A et al. Drug-induced agranulocytosis: evidence for the commitment of bone marrow haematopoiesis. Scand J Haematol 1985; 35: 459-468
• 9 Yang J, Zhong J, Xiao XH et al. The relationship between bone marrow characteristics and the clinical prognosis of antithyroid drug-induced agranulocytosis. Endocr J 2013; 60: 185-189
• 10 Tajiri J, Noguchi S, Murakami N. Usefulness of granulocyte count measurement four hours after injection of granulocyte colony-stimulating factor for detecting recovery from antithyroid drug-induced granulocytopenia. Thyroid 1997; 7: 575-578
• 11 Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: how has granulocyte colony-stimulating factor changed therapy?. Thyroid 2005; 15: 292-297
• 12 Fukata S, Kuma K, Sugawara M. Granulocyte colony-stimulating factor (G-CSF) does not improve recovery from antithyroid drug-induced agranulocytosis: a prospective study. Thyroid 1999; 9: 29-31