Ballestrero A, Ferrando F, Garuti A, Basta P, Gonella R, Stura P, Mela G S, Sessarego M, Gobbi M, Patrone F
Department of Internal Medicine, University of Genoa, Genoa, Italy.
J Clin Oncol. 1999 Apr;17(4):1296. doi: 10.1200/JCO.1999.17.4.1296.
To compare the toxicity and effects on hematologic recovery and circulating progenitor cell mobilization of three cytokine regimens administered after high-dose cyclophosphamide (HD-CTX; 6 g/m(2)), given as the first step of a high-dose sequential chemotherapy.
Forty-eight patients with breast cancer or non-Hodgkin's lymphoma were randomized to receive granulocyte colony-stimulating factor (G-CSF) alone (arm 1), granulocyte-macrophage colony-stimulating factor (GM-CSF) alone (arm 2), or sequential interleukin-3 (IL-3) and GM-CSF (arm 3). Cytokines were administered as a single daily subcutaneous injection at a dose of 5 to 6 microg/kg/d. Progenitor cells were evaluated in peripheral blood as well as in apheretic product as both CD34(+) cells and granulocyte-macrophage colony-forming units (CFU-GM).
Neutrophil recovery was faster in arm 1 as compared with arms 2 and 3 (P <.0001); no significant differences were observed between arms 2 and 3. In arm 3, a moderate acceleration of platelet recovery was observed, but it was statistically significant only as compared with arm 1 (P =.028). The peak of CD34(+) cells was hastened in a median of 2 days in arm 1 compared with arms 2 and 3 (P =.0002), whereas the median peak value of CD34(+) cells and CFU-GM was similar in the three patient groups. Administration of IL-3 and GM-CSF resulted in more significant toxicity requiring pharmacologic treatment in 90% of patients.
The three cytokine regimens administered after HD-CTX are comparably effective in reducing hematologic toxicity and mobilizing the hematopoietic progenitor cells. G-CSF accelerates leukocyte recovery and progenitor mobilization. Although G-CSF-treated patients have somewhat slower platelet recovery, they definitely have fewer side effects.
比较三种细胞因子方案在大剂量环磷酰胺（HD-CTX；6 g/m²）作为大剂量序贯化疗第一步给药后，对毒性、血液学恢复及循环祖细胞动员的影响。
48例乳腺癌或非霍奇金淋巴瘤患者被随机分为三组，分别接受单独使用粒细胞集落刺激因子（G-CSF）（第1组）、单独使用粒细胞-巨噬细胞集落刺激因子（GM-CSF）（第2组）或序贯使用白细胞介素-3（IL-3）和GM-CSF（第3组）。细胞因子通过每日一次皮下注射给药，剂量为5至6 μg/kg/d。在外周血以及采集的产品中评估祖细胞，检测指标包括CD34⁺细胞和粒细胞-巨噬细胞集落形成单位（CFU-GM）。
与第2组和第3组相比，第1组中性粒细胞恢复更快（P <.0001）；第2组和第3组之间未观察到显著差异。在第3组中，观察到血小板恢复有适度加速，但仅与第1组相比有统计学意义（P =.028）。与第2组和第3组相比，第1组CD34⁺细胞峰值提前中位2天出现（P =.0002），而三组患者中CD34⁺细胞和CFU-GM的中位峰值相似。IL-3和GM-CSF的联合使用导致更显著的毒性，90%的患者需要药物治疗。
HD-CTX后给予的三种细胞因子方案在降低血液学毒性和动员造血祖细胞方面效果相当。G-CSF可加速白细胞恢复和祖细胞动员。虽然接受G-CSF治疗的患者血小板恢复稍慢，但副作用明显较少。
