Menichella G, Pierelli L, Foddai M L, Paoloni A, Vittori M, Serafini R, Benedetti Panici P, Scambia G, Baiocchi G, Greggi S
Servizio di Ematologia ed Emotrasfusione, Catholic University, Rome, Italy.
Br J Haematol. 1991 Nov;79(3):444-50. doi: 10.1111/j.1365-2141.1991.tb08053.x.
We investigated the feasibility of a programme of autologous blood stem cell (ABSC) harvesting and transplantation in 13 patients with advanced ovarian cancer, previously untreated by chemotherapy or radiotherapy and entering a phase II study of high-dose cisplatin, etoposide and carboplatin with haematopoietic stem cell rescue. Prior to high-dose treatment all patients underwent two courses of cisplatin and cyclophosphamide. An 8-fold increase of the peripheral colony forming unit granulocytic-macrophage (CFU-GM) was observed during recovery from myelosuppression after the first chemotherapy course. The second course determined a 2.5-fold increase of peripheral CFU-GM. In 70% of enrolled patients (nine patients) we were able to perform ABSC harvesting by leukaphereses; in the apheresed patients we harvested an average of 20.8 x 10(4)/kg CFU-GM (range 10.9-37.0). Haematopoietic trilineage engraftment, established as the number of days necessary to reach white blood cells (WBC) greater than 1.0 x 10(9)/l, polymorphonuclear leucocytes (PMN) greater than 0.5 x 10(9)/l and platelets (PLT) greater than 50 x 10(9)/l, occurred very promptly and was sustained in the same series after high-dose cisplatin, carboplatin and etoposide, followed by autologous blood stem cell transplantation (ABSCT). In our experience we found a significant correlation (r = 0.77; P less than 0.05) between CFU-GM infused dose and the engraftment speed of PMN. We conclude that the combination of cisplatin and cyclophosphamide is effective in mobilizing haematopoietic progenitors in the peripheral blood of patients with advanced ovarian cancer, previously untreated by chemoradiotherapy. Moreover, ABSCT is capable of rapidly restoring the haematopoietic function after high-dose treatment and for this reason it represents a particularly advisable therapeutic option for the treatment of solid tumours because these patients are commonly older than 50 and can be excluded from bone marrow transplantation.
我们对13例晚期卵巢癌患者进行了自体血干细胞（ABSC）采集与移植方案的可行性研究，这些患者此前未接受过化疗或放疗，正进入一项高剂量顺铂、依托泊苷和卡铂联合造血干细胞救援的II期研究。在高剂量治疗前，所有患者均接受了两个疗程的顺铂和环磷酰胺治疗。在第一个化疗疗程后骨髓抑制恢复期间，观察到外周血粒系巨噬系集落形成单位（CFU-GM）增加了8倍。第二个疗程使外周血CFU-GM增加了2.5倍。在70%的入组患者（9例患者）中，我们能够通过白细胞分离术进行ABSC采集；在进行白细胞分离术的患者中，我们平均采集到20.8×10⁴/kg CFU-GM（范围为10.9 - 37.0）。造血三系植入以达到白细胞（WBC）大于1.0×10⁹/L、多形核白细胞（PMN）大于0.5×10⁹/L和血小板（PLT）大于50×10⁹/L所需的天数来确定，在高剂量顺铂、卡铂和依托泊苷治疗后紧接着进行自体血干细胞移植（ABSCT）时，植入非常迅速且在同一组患者中得以维持。根据我们的经验，我们发现注入的CFU-GM剂量与PMN的植入速度之间存在显著相关性（r = 0.77；P < 0.05）。我们得出结论，顺铂和环磷酰胺联合用药在动员先前未接受过放化疗的晚期卵巢癌患者外周血中的造血祖细胞方面是有效的。此外，ABSCT能够在高剂量治疗后迅速恢复造血功能，因此对于实体瘤的治疗而言，它是一种特别可取的治疗选择，因为这些患者通常年龄大于50岁，可被排除在骨髓移植之外。
