Socie Gerard, Mary Jean-Yves, Schrezenmeier Hubert, Marsh Judith, Bacigalupo Andrea, Locasciulli Anna, Fuehrer Monica, Bekassy Albert, Tichelli Andre, Passweg Jakob
Service d'Hématologie Greffe, and Institut National de la Santé et de la Recherche Médicale (INSERM) U728, Hospital Saint Louis, Paris, France.
Blood. 2007 Apr 1;109(7):2794-6. doi: 10.1182/blood-2006-07-034272.
Previous studies suggested a link between the use of G-CSF and increased incidence of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) after immunosuppressive therapy (IST) for severe aplastic anemia (SAA). This European survey included 840 patients who received a first-line IST with (43%) or without (57%) G-CSF. The incidences of MDS/AML in patients who did or did not receive G-CSF were 10.9% and 5.8%, respectively. A significantly higher hazard (1.9) of MDS/AML was associated with use of G-CSF. Relapse of aplastic anemia was not associated with a worse outcome in patients who did not receive G-CSF as first therapy, whereas relapse was associated with a significantly worse outcome in those patients who received G-CSF. These results emphasize the necessity of the current European randomized trial comparing IST with or without G-CSF and to alert physicians that adding G-CSF to IST is currently not standard treatment for SAA.
先前的研究表明，在针对重型再生障碍性贫血（SAA）进行免疫抑制治疗（IST）后，使用粒细胞集落刺激因子（G-CSF）与骨髓增生异常综合征（MDS）和急性髓系白血病（AML）发病率增加之间存在关联。这项欧洲调查纳入了840例接受一线IST治疗的患者，其中43%的患者使用了G-CSF，57%的患者未使用G-CSF。接受或未接受G-CSF治疗的患者中，MDS/AML的发病率分别为10.9%和5.8%。使用G-CSF与MDS/AML的显著更高风险（1.9）相关。对于未将G-CSF作为首次治疗的再生障碍性贫血患者，复发与较差的预后无关，而对于接受G-CSF治疗的患者，复发与显著更差的预后相关。这些结果强调了当前欧洲进行的比较使用或不使用G-CSF的IST的随机试验的必要性，并提醒医生，在IST中添加G-CSF目前并非SAA的标准治疗方法。
