Filgrastim and premature ventricular contractions

What is it about?

we report on a child with B thalassemia, who developed premature ventricular contractions attributed to the use of G-CSF ( filgrastim). The child received 3 doses of filgrastim at 10u/kg, as a part of management of febrile neutropenia. He was using deferiprone to control his iron overload status for 6 years before the development of agranulocytosis, that was complicated by fever and facial cellulitis. After the 3rd dose of G-CSF, he was noted to have irregular heart beats on routine clinical examination. ECG confirmed the presence of frequent premature contractions, that were asymptomatic. Workup to rule out possible causes of his arrhythmia revealed normal electrolyte levels, normal cardiac structure and function on ECHO examination, and low cardiac iron status on cardiac MRI T2*. G-CSF was stopped, and his clinical status was monitored. The arrhythmia disappeared after 2 weeks

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Why is it important?

Cardiac monitoring of children treated with G-CSF is important, to detect and early manage potentially dangerous arrhythmia.

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