Fritsch Peter, Schwinger Wolfgang, Schwantzer Gerold, Lackner Herwig, Sovinz Petra, Wendelin Gerald, Benesch Martin, Sipurzynski Sabine, Urban Christian
Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Pediatr Blood Cancer. 2010 Jan;54(1):134-7. doi: 10.1002/pbc.22304.
Pegfilgrastim, the long acting agent of rh-GCSF, has been shown to be as effective as Filgrastim in children undergoing cytotoxic chemotherapy by reducing the duration of neutropenia. Recent studies in adults have also shown that Pegfilgrastim is effective to mobilize CD34+ stem cells, resulting in earlier peripheral stem cell collections (PSCC). The aim of the study was to compare the efficacy of Pegfilgrastim with Filgrastim for CD34+ stem cell mobilization in children.
Three groups of patients were compared: Group 1: six patients with Ewing Sarcoma stimulated with Filgrastim; Group 2: five patients with Ewing Sarcoma, Ependymoma, and Neuroblastoma; Group 3: four patients with relapsed neoplasm. Patients of Group 2 and 3 were stimulated with Pegfilgrastim followed by peripheral stem cell collection. Two patients in Group 3 needed further cytokine stimulation with Filgrastim combined with stem cell factor, Ancestim.
In Groups 1-3, a median of 4, 3, and 3 PSCC between day 12-24, 6-13, and 8-30 were performed, yielding a median of 14.2, 24.0, and 10.3 x 10(6) CD34+ stem cells/kg BW, respectively.
Group 2 data show that stem cell mobilization with Pegfilgrastim in children when performed during primary or without previous long lasting chemotherapy seems to produce earlier CD34+ peaks and better CD34+ yields than in Group 1. CD34+ cell mobilization with Pegfilgrastim in Group 3-patients with previous long lasting chemotherapy was possible.
聚乙二醇化重组人粒细胞集落刺激因子（Pegfilgrastim）是重组人粒细胞集落刺激因子（rh - GCSF）的长效制剂，已证明其在接受细胞毒性化疗的儿童中，通过缩短中性粒细胞减少的持续时间，与非格司亭（Filgrastim）效果相当。近期针对成人的研究也表明，Pegfilgrastim在动员CD34 +干细胞方面有效，可使外周血干细胞采集（PSCC）更早进行。本研究的目的是比较Pegfilgrastim与Filgrastim在儿童中动员CD34 +干细胞的疗效。
比较三组患者：第1组：6例尤因肉瘤患者接受非格司亭刺激；第2组：5例尤因肉瘤、室管膜瘤和神经母细胞瘤患者；第3组：4例复发肿瘤患者。第2组和第3组患者接受Pegfilgrastim刺激，随后进行外周血干细胞采集。第3组中有2例患者需要用非格司亭联合干细胞因子（Ancestim）进行进一步的细胞因子刺激。
在第1 - 3组中，分别在第12 - 24天、6 - 13天和8 - 30天进行了中位数为4次、3次和3次的外周血干细胞采集，分别获得中位数为14.2×10⁶、24.0×10⁶和10.3×10⁶个CD34 +干细胞/kg体重。
第2组数据表明，在儿童中，当在初次治疗期间或无先前长期化疗的情况下使用Pegfilgrastim进行干细胞动员时，似乎比第1组产生更早的CD34 +峰值和更高的CD34 +产量。在第3组先前接受过长期化疗的患者中，使用Pegfilgrastim进行CD34 +细胞动员是可行的。
