Harmenberg J, Höglund M, Hellström-Lindberg E
Department of Virology, Swedish Institute for Infectious Disease Control, Stockholm.
Eur J Haematol Suppl. 1994;55:1-28. doi: 10.1111/j.1600-0609.1994.tb01617.x.
Administration of G- and GM-CSF increases the neutrophil counts in a number of clinical situations. GM-CSF shows the additional effect of increasing the number of monocytes and eosinophil granulocytes. Both G- and GM-CSF affect of neutrophil functions, in the case of GM-CSF there are some potentially negative effects on neutrophil migration and adhesiveness. The clinical relevance of the various effects on mature haematopoietic cells is not fully understood. Clinical data with G-CSF treatment indicate that increased levels of neutrophil granulocytes following cytotoxic chemotherapy may translate into clinical benefit such as a decreased rate of neutropenic infection and an increased cytotoxic chemotherapy dose even though the data are conflicting and the risk of "laboratory cosmetics" is apparent. Regarding treatment with GM-CSF following chemotherapy, the clinical benefit is unclear. The clinical benefit of GM-CSF-induced monocytes and eosinophils is unknown. G- and GM-CSF accelerates neutrophil recovery following autologous or allogeneic BMT. The influence on neutropenic infections is, however, less impressive. Pretreatment with G- or GM-CSF increases the yield of peripheral stem cell harvest, thereby reducing the number of leukaphereses needed. Transplantation of G- and GM-CSF primed autologous peripheral stem cells tends to reduce the period of post-transplant cytopenia, particularly thrombocytopenia, in comparison with traditional ABMT. In patients with MDS, G- and GM-CSF appear to increase the number of neutrophil granulocytes and there is some evidence that patients with severe infectious problems will benefit from this treatment. However, little influence was seen on the main clinical problems with these patients, which are anaemia and thrombocytopenia. In conclusion, G- and GM-CSF are two different proteins with different properties in vivo and in vitro. GM-CSF has, compared with G-CSF, more complex pharmacological effects and a more trouble-some side-effect profile. Early clinical development indicates that both compounds have a substantial influence on the levels of certain blood cells. Whether the increases in different blood cells translate into long-term clinical benefit for greater patient groups is the focus of ongoing research. The effects of G- and GM-CSF may be potentiated by other cytokines, an area which is presently being explored.
在多种临床情况下，给予粒细胞集落刺激因子（G-CSF）和粒细胞-巨噬细胞集落刺激因子（GM-CSF）可增加中性粒细胞计数。GM-CSF还具有增加单核细胞和嗜酸性粒细胞数量的额外作用。G-CSF和GM-CSF均会影响中性粒细胞功能，就GM-CSF而言，对中性粒细胞迁移和黏附存在一些潜在的负面影响。对成熟造血细胞的各种影响的临床相关性尚未完全明了。G-CSF治疗的临床数据表明，细胞毒性化疗后中性粒细胞水平升高可能转化为临床益处，如中性粒细胞减少性感染发生率降低以及细胞毒性化疗剂量增加，尽管数据存在矛盾且“实验室修饰”的风险明显。关于化疗后GM-CSF治疗，临床益处尚不清楚。GM-CSF诱导的单核细胞和嗜酸性粒细胞的临床益处未知。G-CSF和GM-CSF可加速自体或异基因骨髓移植（BMT）后中性粒细胞的恢复。然而，对中性粒细胞减少性感染的影响并不显著。G-CSF或GM-CSF预处理可提高外周干细胞采集量，从而减少所需的白细胞单采次数。与传统的自体骨髓移植（ABMT）相比，移植经G-CSF和GM-CSF预处理的自体外周干细胞往往可缩短移植后血细胞减少期，尤其是血小板减少期。在骨髓增生异常综合征（MDS）患者中，G-CSF和GM-CSF似乎可增加中性粒细胞数量，并且有一些证据表明存在严重感染问题的患者将从这种治疗中获益。然而，对这些患者的主要临床问题（贫血和血小板减少）影响甚微。总之，G-CSF和GM-CSF是两种在体内和体外具有不同特性的不同蛋白质。与G-CSF相比，GM-CSF具有更复杂的药理作用和更麻烦的副作用谱。早期临床研究表明，这两种化合物对某些血细胞水平有重大影响。不同血细胞数量的增加是否能为更多患者群体带来长期临床益处是正在进行研究 的重点。G-CSF和GM-CSF 的作用可能会被其他细胞因子增强，目前正在探索这一领域。
