Lazarus H M, Rowe J M
Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Ohio.
Blood Rev. 1994 Sep;8(3):169-78. doi: 10.1016/0268-960x(94)90078-v.
The use of the recombinant hematopoietic growth factors G-CSF and GM-CSF have shortened the period of neutropenia, or avoided this problem, in many cancer patients who have received cytotoxic therapy. Although these benefits have been particularly striking in the autologous bone marrow and/or autologous peripheral blood progenitor cell transplant setting, most data suggest that the use of G-CSF and GM-CSF only marginally enhance recovery of the neutrophil count when administered after allogeneic bone marrow infusion. Furthermore, in the allograft setting these expensive agents have not provided benefit in the form of enhanced platelet count recovery, lessening the incidence of graft-versus-host disease, or improvement in overall survival. These data do not justify routine widespread use of G-CSF and GM-CSF and suggest that these agents should be reserved for patients who experience delay in engraftment after allogeneic bone marrow infusion. Administration of erythropoietin, on the other hand, may reduce the need for homologous red blood cell transfusions, and may increase the safety margin for both the allogeneic bone marrow recipient and as well as the donor. Recombinant hematopoietic growth factors targetted specifically to enhance platelet recovery after transplantation (such as interleukin-3, interleukin-6, and interleukin-11) have shown promise after autotransplantation and after conventional dose chemotherapy, and likely will be evaluated in the allogeneic transplant patient.
重组造血生长因子G-CSF和GM-CSF的使用，已缩短了许多接受细胞毒性治疗的癌症患者的中性粒细胞减少期，或避免了这一问题。尽管这些益处自体骨髓和/或自体外周血祖细胞移植中尤为显著，但大多数数据表明，在异基因骨髓输注后使用G-CSF和GM-CSF，对中性粒细胞计数恢复的促进作用甚微。此外，在同种异体移植中，这些昂贵的药物并未在提高血小板计数恢复率、降低移植物抗宿主病发生率或改善总生存率方面带来益处。这些数据无法证明G-CSF和GM-CSF可常规广泛使用，表明这些药物应保留给异基因骨髓输注后植入延迟的患者。另一方面，促红细胞生成素的使用可能会减少对同源红细胞输血的需求，并可能增加异基因骨髓接受者以及供体的安全边际。专门用于提高移植后血小板恢复率的重组造血生长因子（如白细胞介素-3、白细胞介素-6和白细胞介素-11），在自体移植和常规剂量化疗后已显示出前景，可能会在异基因移植患者中进行评估。
