Kroschinsky Frank, Hölig Kristina, Platzbecker Uwe, Poppe-Thiede Kirsten, Ordemann Rainer, Blechschmidt Matthias, Oelschlaegel Uta, Schaich Markus, Hänel Mathias, Bornhäuser Martin, Ehninger Gerhard
1st Medical Department, University Hospital Dresden, Dresden, Germany.
Transfusion. 2006 Aug;46(8):1417-23. doi: 10.1111/j.1537-2995.2006.00911.x.
A single injection of pegfilgrastim has been shown to be equivalent to daily filgrastim in enhancing neutrophil recovery after chemotherapy, whereas the experiences with pegfilgrastim in mobilization of peripheral blood progenitor cells (PBPCs) are limited.
Forty unselected patients with lymphoma or multiple myeloma were treated with different chemotherapy regimens followed by 6 mg of pegfilgrastim for mobilization of autologous PBPCs. Patients with an inadequate mobilization (blood CD34+ cells <or= 10/microL after nadir) were given additional daily doses of 10 microg per kg unconjugated filgrastim.
A median blood CD34+ peak concentration of 81 per microL (range, 10-565/microL) was found in 30 patients, who had only received pegfilgrastim, compared to 13 per microL (median, range 4-71/microL; p < 0.001) in 10 poor mobilizing patients with additional filgrastim. The median yield of CD34+ cells was 9.8 x 10(6) per kg (range, 1.5-88.1) after pegfilgrastim only versus 2.5 x 10(6) (range, 1.7-7.0) in poor mobilizers. Patients who needed additional cytokine administration were those with a more extensive previous antineoplastic treatment and mobilizing regimens containing PBPC toxic agents.
The results confirm the efficacy and feasibility of PBPC mobilization with chemotherapy and single-dose pegfilgrastim in patients with lymphoproliferative malignacies. In less heavily pretreated patients, 6 mg of pegfilgrastim after chemotherapy induced an adequate mobilization, whereas dose and schedule in patients after numerous cytotoxic regimens need further investigation.
在化疗后促进中性粒细胞恢复方面，单次注射聚乙二醇化重组人粒细胞刺激因子已被证明等同于每日注射重组人粒细胞刺激因子，然而聚乙二醇化重组人粒细胞刺激因子在外周血祖细胞（PBPC）动员方面的经验有限。
40例未经选择的淋巴瘤或多发性骨髓瘤患者接受不同的化疗方案，随后给予6毫克聚乙二醇化重组人粒细胞刺激因子以动员自体PBPC。动员不足（最低点后血液CD34+细胞≤10/微升）的患者每日额外给予每千克10微克非共轭重组人粒细胞刺激因子。
30例仅接受聚乙二醇化重组人粒细胞刺激因子的患者血液CD34+峰值浓度中位数为每微升81个（范围为10 - 565/微升），相比之下，10例动员不佳且额外接受重组人粒细胞刺激因子的患者为每微升13个（中位数，范围4 - 71/微升；p < 0.001）。仅使用聚乙二醇化重组人粒细胞刺激因子后CD34+细胞的中位数产量为每千克9.8×10⁶个（范围为1.5 - 88.1），而动员不佳者为2.5×10⁶个（范围为1.7 - 7.0）。需要额外给予细胞因子的患者是那些既往接受过更广泛抗肿瘤治疗且动员方案中含有PBPC毒性药物的患者。
结果证实了化疗联合单剂量聚乙二醇化重组人粒细胞刺激因子在淋巴增殖性恶性肿瘤患者中进行PBPC动员的有效性和可行性。在预处理较轻的患者中，化疗后6毫克聚乙二醇化重组人粒细胞刺激因子可诱导充分的动员，而在接受多种细胞毒性方案治疗的患者中，剂量和给药方案需要进一步研究。
