Waller C F, von Lintig F, Daskalakis A, Musahl V, Lange W
Department of Internal Medicine I, Hematology/Oncology, Albert-Ludwigs-University Freiburg, Medical Center, Germany.
Bone Marrow Transplant. 1999 Jul;24(1):19-24. doi: 10.1038/sj.bmt.1701860.
Peripheral blood progenitor cells (PBPC) can be mobilized by chemotherapy, cytokines, or the combination of both. Recently, data from two non-randomized studies were published, showing an advantage for a combination of rhG-CSF plus rhEpo compared to rhG-CSF alone in mobilization of PBPC. To address this question we initiated a prospective, randomized trial in patients with breast cancer. Thirty (28 female, two male) of 32 randomized patients were evaluable. After primary surgery, therapy consisted of two cycles of VIP-E chemotherapy followed by high-dose (HD) chemotherapy with VIC. Mobilization and harvest of PBPC followed cycle 2. Group A received 5 microg rhG-CSF/kg body weight (bw) plus 150 IU rhEpo/kg bw. Group B was treated with 5 microg rhG-CSF/kg bw from dl until end of harvest. In the peripheral blood CD34+ cells as well as colony-forming units (CFU) started to rise on d8 with a peak on d10, followed by a decrease. No significant differences were observed between the groups. Furthermore, there was no significant difference with regard to MNC, CD34+ cells BFU-E and CFU-GM in apheresis products. Transplantation of > 1 x 10(6) CD34+ cells/kg bw after HD chemotherapy resulted in normal hematological recovery of all patients. No differences were observed in time to neutrophil or platelet recovery and need for blood product support. In this study addition of rhEpo to our standard mobilization chemotherapy did not result in improved mobilization of PBPC or in clinical benefits after HD chemotherapy.
外周血祖细胞（PBPC）可通过化疗、细胞因子或两者联合进行动员。最近，两项非随机研究的数据发表，显示与单独使用重组人粒细胞集落刺激因子（rhG-CSF）相比，rhG-CSF加重组人促红细胞生成素（rhEpo）联合使用在PBPC动员方面具有优势。为解决这个问题，我们对乳腺癌患者开展了一项前瞻性随机试验。32例随机分组患者中有30例（28例女性，2例男性）可进行评估。初次手术后，治疗包括两个周期的VIP-E化疗，随后进行VIC高剂量（HD）化疗。PBPC的动员和采集在第2周期后进行。A组接受5μg rhG-CSF/kg体重（bw）加150 IU rhEpo/kg bw。B组从第1天至采集结束接受5μg rhG-CSF/kg bw治疗。外周血中CD34+细胞以及集落形成单位（CFU）在第8天开始上升，第10天达到峰值，随后下降。两组之间未观察到显著差异。此外，在采集产品中的单核细胞（MNC）、CD34+细胞、爆式红系集落形成单位（BFU-E）和粒-巨噬细胞集落形成单位（CFU-GM）方面也没有显著差异。HD化疗后移植>1×10⁶ CD34+细胞/kg bw可使所有患者的血液学恢复正常。在中性粒细胞或血小板恢复时间以及血液制品支持需求方面未观察到差异。在本研究中，在我们的标准动员化疗中添加rhEpo并未导致PBPC动员改善或HD化疗后出现临床益处。
