Patrone F, Ballestrero A, Balleari E, Bogliolo F, Brema F, Ferrando F, Ghio R, Timitilli S
Dipartimento di Medicina Interna, Università di Genova, Italy.
Haematologica. 1992 Nov-Dec;77(6):457-62.
Several methods for the recruitment of circulating progenitor cells (CPC) to be used for hemopoietic rescue after myeloablative therapy have been described. The present study was designed to verify the effectiveness and safeness of one of such procedures, involving the administration of high-dose cyclophosphamide (HD-CTX) and granulocyte-macrophage colony-stimulating factor (GM-CSF).
Eight tumor patients were treated with HD-CTX (7 g/m2), followed by GM-CSF (7 mcg/Kg/day, continuous infusion) from day +2 to the completion of leukocyte recovery, when aphereses for CPC harvesting were performed. CPC were evaluated by clonogenic assay for granulocyte-macrophage colony-forming units (CFU-GM), megakaryocyte colony-forming units (CFU-Meg) and erythrocyte burst-forming units (BFU-E) before therapy as well as during the hemopoietic recovery.
In each patient, a significant increase of trilineage CPC was observed, at a mean of 14 days from HD-CTX, with peak increment of 224, 268 and 230-fold for CFU-GM, CFU-Meg and BFU-E respectively. The mean duration of leukocyte count < or = 0.5 x 10(9)/l was 6.6 days, with severe thrombocytopenia (grade 4 WHO) lasting 2.8 days in 5 patients. GM-CSF infusion was well tolerated without any need for dose reduction or discontinuation.
The administration of HD-CTX and GM-CSF induces a significant enhancement of CPC including CFU-Meg other than CFU-GM and BFU-E. The procedure is suitable for the recruitment of CPC in patients with CTX sensitive tumors.
已有多种用于在清髓性治疗后募集循环祖细胞（CPC）以进行造血救援的方法被描述。本研究旨在验证其中一种方法的有效性和安全性，该方法涉及给予大剂量环磷酰胺（HD - CTX）和粒细胞 - 巨噬细胞集落刺激因子（GM - CSF）。
8名肿瘤患者接受HD - CTX（7 g/m²）治疗，随后从第 +2天开始至白细胞恢复完成时给予GM - CSF（7 mcg/Kg/天，持续输注），此时进行用于采集CPC的单采术。在治疗前以及造血恢复期间，通过克隆形成试验对CPC进行评估，检测粒细胞 - 巨噬细胞集落形成单位（CFU - GM）、巨核细胞集落形成单位（CFU - Meg）和红细胞爆式集落形成单位（BFU - E）。
在每位患者中，均观察到三系CPC显著增加，平均在HD - CTX治疗后14天出现，CFU - GM、CFU - Meg和BFU - E的峰值分别增加224倍、268倍和230倍。白细胞计数≤0.5×10⁹/L的平均持续时间为6.6天，5名患者出现严重血小板减少（WHO 4级），持续2.8天。GM - CSF输注耐受性良好，无需降低剂量或停药。
给予HD - CTX和GM - CSF可显著增强CPC，包括CFU - Meg以及CFU - GM和BFU - E。该方法适用于募集CTX敏感肿瘤患者的CPC。
