Studies on levamisole-induced agranulocytosis

J. S. Thompson, J. M. Herbick, L. W. Klassen, C. D. Severson, V. L. Overlin, J. W. Blaschke, M. A. Silverman, C. L. Vogel

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54 Scopus citations

Abstract

Widespread clinical trials of laevo-tetramisole (levamisole) as an immunopotentiating agent in rheumatoid arthritis, metastatic carcinoma, and immunodeficiency states have been complicated by agranulocytosis (AGC) in 2.5%-13% of patients. Other than a relationship with prolonged high dosage, very little is known regarding the pathogenesis of levamisole-induced AGC. Whereas leukoagglutination was negative, fluorochromatic microgranulocytotoxicity (GCY) tests were positive with serum from 10 of 10 acutely neutropenic patients. The antibody was IgM, reacted with 100% of unrelated granulocytes, but not with T or B lymphocytes. Some sera also reacted with monocytes and the myeloid cell line, K-562. Tests for antigen-antibody complexes or cold autoantibodies were negative. Although clinical evidence strongly suggests a haptene (drug) mechanism, in vitro mixing experiments were also negative. An alternative choice parallels the model of aldomet-induced Coombs'-positive hemolytic anemia. Finally, GCY first became positive 2-3 mo prior to the onset of AGC in two patients, suggesting the possibility of identifying those at risk well before the onset of neutropenia.

Original languageEnglish (US)
Pages (from-to)388-396
Number of pages9
JournalBlood
Volume56
Issue number3
StatePublished - Dec 1 1980

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Thompson, J. S., Herbick, J. M., Klassen, L. W., Severson, C. D., Overlin, V. L., Blaschke, J. W., Silverman, M. A., & Vogel, C. L. (1980). Studies on levamisole-induced agranulocytosis. Blood, 56(3), 388-396.