Liang D C, Chen S H, Lean S F
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Am J Hematol. 1995 Feb;48(2):76-81. doi: 10.1002/ajh.2830480202.
The granulocyte colony-stimulating factor (G-CSF) has been shown to accelerate recovery from severe neutropenia and to decrease the incidence of documented infections after intensive chemotherapy in cancer patients. However, the routine prophylactic use of G-CSF is expensive. This study was conducted to determine the role of G-CSF as adjunct therapy for septicemia following neutropenia caused by chemotherapy in children with acute leukemia. Fifty consecutive episodes of septicemia were studied involving 34 episodes of Gram-negative, 7 episodes of Gram-positive, 5 episodes of polymicrobial bacterial septicemia, one episode of fungemia, and 3 episodes of disseminated fungal infection. In the first 25 episodes, G-CSF was not used (group A). For the next 16 episodes, G-CSF 200 micrograms per square meter per day subcutaneously was given immediately after the septicemia was documented until the absolute neutrophil count was maintained at more than 1,500 per cubic millimeter (group B). Thereafter, G-CSF at the same dose as that of group B was prophylactically used in all the children who received high-dose cytosine arabinoside-containing regimens. Nine episodes of septicemia occurred (group C). The incidences of mortality per episode of septicemia in groups A, B, and C were 12.0% (3/25), 12.5% (2/16) and 0% (0/9), respectively. Statistically, there was no difference between the three groups overall and in pair-wise comparisons (all P > 0.5). The durations of G-CSF administration in group B ranged from 6 to 26 days with a median of 12 days and the durations of G-CSF administration in group C ranged from 10 to 23 days with a median of 19 days. With or without G-CSF, there may be no significant difference in the mortality of septicemia following neutropenia caused by chemotherapy in children with acute leukemia.
粒细胞集落刺激因子（G-CSF）已被证明可加速严重中性粒细胞减少症的恢复，并降低癌症患者强化化疗后有记录感染的发生率。然而，G-CSF的常规预防性使用费用昂贵。本研究旨在确定G-CSF作为急性白血病儿童化疗后中性粒细胞减少引起的败血症辅助治疗的作用。研究了连续50例败血症病例，其中革兰阴性菌败血症34例，革兰阳性菌败血症7例，多微生物细菌性败血症5例，真菌血症1例，播散性真菌感染3例。在前25例病例中，未使用G-CSF（A组）。在接下来的16例病例中，败血症确诊后立即皮下给予G-CSF 200微克/平方米/天，直至绝对中性粒细胞计数维持在每立方毫米1500以上（B组）。此后，所有接受含大剂量阿糖胞苷方案的儿童均预防性使用与B组相同剂量的G-CSF。发生了9例败血症（C组）。A、B、C三组败血症每例的死亡率分别为12.0%（3/25）、12.5%（2/16）和0%（0/9）。统计学上，三组总体及两两比较均无差异（所有P>0.5）。B组G-CSF给药时间为6至26天，中位数为12天，C组G-CSF给药时间为10至23天，中位数为19天。对于急性白血病儿童化疗后中性粒细胞减少引起的败血症，无论是否使用G-CSF，死亡率可能无显著差异。
