Acute arterial thrombosis after escalated‐dose methotrexate, vinblastine, doxorubicin, and cisplatin chemotherapy with recombinant granulocyte colony‐stimulating factor: A possible new recombinant granulocyte colony‐stimulating factor toxicity

Combination chemotherapy with a regimen of methotrexate, vinblastine, doxorubicin, and cisplatin (M‐VAC) has produced long‐term survival times in a significant proportion of patients with advanced nodal and meta‐static urothelial tumors. The availability of the colony‐stimulating factors has spurred interest in studies evaluating escalated dosing schedules of M‐VAC in an attempt to improve major response rates and overall survival. More frequent use of the colony‐stimulating factors, however, in this and other settings may be associated with unrecognized side effects. The authors report a case of arterial thrombosis in a 69‐year‐old man receiving recombinant granulocyte colony‐stimulating factor (rhG‐CSF) and escalated‐dose M‐VAC for treatment of a transitional cell carcinoma of the bladder. Incidents of venous thrombosis have been reported previously with the use of colony‐stimulating factors, but, to the knowledge of the authors, this case represents the first report of an arterial thrombosis occurring in a patient receiving rhG‐CSF.