Jacoub Jack F, Suryadevara Uma, Pereyra Vivian, Colón Donna, Fontelonga Antonio, Mackintosh F Roy, Hall Stephen W, Ascensão João L
Division of Hematology/Oncology, University of Nevada, School of Medicine, Veterans Affairs Medical Center, Washoe Medical Center, Reno, Nevada, USA.
Exp Hematol. 2006 Nov;34(11):1443-50. doi: 10.1016/j.exphem.2006.06.022.
Given the potential to limit cost, we conducted a pilot study evaluating delayed, low-dose granulocyte colony-stimulating factor (G-CSF) following chemotherapy for the procurement of peripheral blood progenitor cells (PBPCs) for autologous transplantation and reviewed the relevant literature.
Twenty-eight patients with various malignancies received cyclophosphamide 4 gm/m(2) and paclitaxel 170 mg/m2 followed by G-CSF 300 microg/d or 480 microg/d starting day +5 until two to four daily large volume leukapheresis yielded > or =5.0 x 10(6) CD34+ cells. We searched MEDLINE, Pubmed, and EMBASE databases from 1990 to the present to identify papers on PBPC procurement using delayed G-CSF (starting day +4 or later) following chemotherapy.
G-CSF was administered for a median of 9 days at an average cost of 1260 USD per 70-kg patient. Collection was initiated at a median of 12 days after chemotherapy. A median 2.5 (range 2-4) apheresis were performed yielding an average daily CD34+ collection of 6.9 x 10(6)/kg (range 0.35-56.7). After one apheresis, 82% and 57% of patients collected > or =2.5 x 10(6)/kg and > or =5.0 x 10(6)/kg, respectively. Ultimately, 89% collected > or =5.0 x 10(6)/kg. Febrile neutropenia and catheter-related infection developed in five and two patients, respectively. All patients proceeded to transplantation and engrafted successfully with a median of 14.9 x 10(6)/kg (range 1.05-113) cells infused. Eleven published reports were identified involving 590 patients of whom 498 received G-CSF at a dose range of 250 microg/d to 10 microg/kg/d starting day +4 to 15 for a period of 4 to 9 days for PBPC procurement. Among these reports, 62 to 100% and 33 to 96% of patients collected > or =2 to 2.5 x 10(6) and > or =5.0 x 10(6) CD34+ cells, respectively.
The use of delayed, low-dose G-CSF plus chemotherapy for stem cell mobilization was feasible and provides further evidence supporting this potentially cost-effective strategy. A review of the literature supports our findings and emphasizes the need for larger studies to address this issue.
鉴于有可能控制成本，我们开展了一项试点研究，评估化疗后延迟使用低剂量粒细胞集落刺激因子（G-CSF）以采集外周血祖细胞（PBPCs）用于自体移植，并对相关文献进行了综述。
28例患有各种恶性肿瘤的患者接受了4 g/m²的环磷酰胺和170 mg/m²的紫杉醇治疗，随后从第5天开始给予300 μg/d或480 μg/d的G-CSF，直至每天进行两到四次大容量白细胞单采获得≥5.0×10⁶个CD34⁺细胞。我们检索了1990年至今的MEDLINE、Pubmed和EMBASE数据库，以识别关于化疗后延迟使用G-CSF（从第4天或更晚开始）采集PBPCs的论文。
G-CSF的中位给药时间为9天，每70 kg患者的平均费用为1260美元。采集在化疗后中位12天开始。中位进行了2.5次（范围2 - 4次）单采，平均每日CD34⁺细胞采集量为6.9×10⁶/kg（范围0.35 - 56.7）。一次单采后，分别有82%和57%的患者采集到≥2.5×10⁶/kg和≥5.0×10⁶/kg的细胞。最终，89%的患者采集到≥5.0×10⁶/kg的细胞。分别有5例和2例患者发生了发热性中性粒细胞减少和导管相关感染。所有患者均进行了移植，并成功植入，输注细胞的中位数为14.9×10⁶/kg（范围1.05 - 113）。确定了11篇已发表的报告，涉及590例患者，其中498例在第4天至15天开始接受剂量范围为250 μg/d至10 μg/kg/d的G-CSF治疗4至9天以采集PBPCs。在这些报告中，分别有62%至100%和33%至96%的患者采集到≥2至2.5×10⁶个和≥5.0×10⁶个CD34⁺细胞。
延迟使用低剂量G-CSF联合化疗进行干细胞动员是可行的，并为这一潜在的具有成本效益的策略提供了进一步的证据。文献综述支持了我们的研究结果，并强调需要进行更大规模的研究来解决这个问题。
