Buechner T, Hiddemann W, Koenigsmann M, Zuehlsdorf M, Woermann B, Boeckmann A, Aguion Freire E, Innig G, Maschmeyer G, Ludwig W D
Department of Hematology, University of Muenster.
Bone Marrow Transplant. 1990 Jul;6 Suppl 1:131-4.
Chemotherapy (CT) induced critical neutropenia remains a major dose limiting problem in acute leukemias. In order to reduce the phase of risk we gave recombinant human GM-CSF to 30 patients at high risk of early death with acute myeloid leukemia (AML). 19 patients with untreated AML and 1 patient with AML late relapse were 65+ years of age and were treated for CT by the TAD9 regimen. 10 patients at all ages had AML early or second relapse and received S-HAM CT. Starting on day 4 after CT GM-CSF 250 micrograms/m2/d was given by continuous i.v. infusion until neutrophils recovered. GM-CSF reduced the median recovery time of neutrophils by 4 days in the TAD9 and 9 days in the S-HAM CT group when compared to controls. After the CT induced aplasia 3 patients with AML showed a regrowth of their blasts which after the stop of GM-CSF was reversible in 1 patient and unaffectedly continued in 2 patients. 57% of patients attained a complete remission, and the median age of the responders was 65 (34-84) years. Remission duration was not found to be reduced. Thus, GM-CSF reduces CT toxicity with a low risk of promoting the disease and may allow more effective antileukemic treatment.
化疗（CT）诱导的严重中性粒细胞减少仍然是急性白血病中主要的剂量限制问题。为了降低风险期，我们对30例有早期死亡高风险的急性髓系白血病（AML）患者给予重组人粒细胞巨噬细胞集落刺激因子（GM-CSF）。19例未经治疗的AML患者和1例AML晚期复发患者年龄在65岁及以上，采用TAD9方案进行CT治疗。10例各年龄段的患者有AML早期或二次复发，接受了S-HAM CT治疗。在CT治疗后的第4天开始，通过静脉持续输注给予GM-CSF 250微克/平方米/天，直至中性粒细胞恢复。与对照组相比，GM-CSF使TAD9组中性粒细胞的中位恢复时间缩短了4天，使S-HAM CT组缩短了9天。在CT诱导的再生障碍期后，3例AML患者的原始细胞出现再生，在停止GM-CSF治疗后，1例患者的原始细胞再生可逆，2例患者则不受影响地继续。57%的患者达到完全缓解，缓解者的中位年龄为65（34-84）岁。未发现缓解期缩短。因此，GM-CSF可降低CT毒性，促进疾病进展的风险较低，并可能使抗白血病治疗更有效。
