# Multidisciplinary Treatment for Cecal Cancer and Metachronous Liver Metastases in a Patient with Primary Autoimmune Neutropenia

## TL;DR

A patient with autoimmune neutropenia successfully underwent surgery and chemotherapy for cecal cancer and liver metastases with the help of G-CSF.

## Contribution

This case demonstrates the safe use of G-CSF in a patient with AIN undergoing multidisciplinary cancer treatment.

## Key findings

- G-CSF administration increased neutrophil counts sufficiently to allow safe surgery and chemotherapy.
- The patient tolerated multidisciplinary treatment without infectious complications.
- Metachronous liver metastases were successfully managed with chemotherapy and surgery.

## Abstract

Autoimmune neutropenia (AIN) is a rare disease that causes neutropenia due to autoantibodies directed against neutrophils. Neutropenia is associated with an increased risk of infection, such as surgical site infection or febrile neutropenia. To our knowledge, however, there are few reports of surgical or neoadjuvant chemotherapeutic treatments for colorectal cancer with AIN. Herein, we present a case with AIN undergoing multidisciplinary treatment of cecal cancer and metachronous liver metastases.

A 74-year-old woman with AIN presented to our hospital with epigastric pain lasting for 3 weeks. Abdominal CT showed obstructive cecal cancer and swollen regional lymph nodes. She had been under observation for primary AIN in the hematology department in our institution. The blood test revealed white blood cell count of 2300/μL, neutrophil count of 19.4%, and thus absolute neutrophil count of 446/μL. Granulocyte-colony stimulating factor (G-CSF; filgrastim 75 μg) was administered to lower the risk of infectious complications before surgery. After the absolute neutrophil count levels increased sufficiently, laparoscopic ileocecal resection was performed. Pathological findings showed T3N1aM0, pStage IIIB (UICC 8th edition), HER2 score 0, and a RAS codon 12S mutation. Six months after curative surgery, multiple liver metastases appeared. A total of 8 cycles of mFOLFOX6 with bevacizumab, combined with G-CSF (filgrastim 75 μg) were administered. After preoperative chemotherapy, the patient underwent right anterior sectionectomy and partial resection of segment 6. She was uneventful in the postoperative course. Throughout the perioperative period and chemotherapy, no infectious complications were observed.

The administration of G-CSF to prevent neutropenia allowed the patient with AIN to safely undergo multidisciplinary treatment.