Majolino I, Marcenò R, Buscemi F, Scimè R, Vasta S, Indovina A, Pampinella M, Catania P, Santoro A
Department of Hematology, Ospedale Cervello, Palermo, Italy.
Haematologica. 1995 Mar-Apr;80(2):108-14.
Circulating progenitor cells (CPC), when infused in large numbers, rapidly repopulate the marrow after myeloablation with high-dose therapy. In multiple myeloma (MM), as in other disorders, different chemotherapy regimens, including single-as well as multiple-agent chemotherapy, with or without hemopoietic growth factors, have been proposed to mobilize these progenitor cells into the blood. Here we report our experience with a drug combination called VCAD and compare the results to those obtained by adding rhG-CSF to the same combination.
Fourteen MM patients were given one course of VCAD, a chemotherapy association of vincristine 2 mg, cyclophosphamide 4 x 0.5 g/m2, adriamycin 2 x 50 mg/m2 and dexamethasone 4 x 40 mg, before undergoing apheresis to collect CPC for autografting. Seven also received rhG-CSF (filgrastim) 5 mcg/kg/day over the period of apheresis. These latter were allocated to rhG-CSF treatment sequentially from the time the drug became available for clinical use.
Following VCAD-induced pancytopenia, CFU-GM peaked at a median of 853/mL (range 96-4352; 7.6 times basal level). RhG-CSF administration increased CFU-GM levels but not significantly. With rhG-CSF the CFU-GM peak was reached sooner, toxicity was reduced and granulocytopenia less protracted. Fewer aphereses were run in the rhG-CSF group, there were higher yields per single run, and patients began and completed their collection program more quickly.
The VCAD association is able to mobilize CPC in patients with MM, and rhG-CSF is recommended as a fundamental part of the priming schedule.
循环祖细胞（CPC）大量输注后，在大剂量化疗导致骨髓消融后能迅速重新填充骨髓。在多发性骨髓瘤（MM）中，与其他疾病一样，已经提出了不同的化疗方案，包括单药及多药化疗，联合或不联合造血生长因子，以促使这些祖细胞进入血液。在此，我们报告我们使用一种名为VCAD的药物组合的经验，并将结果与在相同组合中添加重组人粒细胞集落刺激因子（rhG-CSF）所获得的结果进行比较。
14例MM患者在进行单采以收集CPC用于自体移植之前，接受了一个疗程的VCAD治疗，即长春新碱2mg、环磷酰胺4×0.5g/m²、阿霉素2×50mg/m²和地塞米松4×40mg的化疗联合方案。7例患者在单采期间还接受了rhG-CSF（非格司亭）5μg/kg/天的治疗。从该药物可用于临床使用时起，后者被依次分配接受rhG-CSF治疗。
在VCAD诱导全血细胞减少后，集落形成单位-粒细胞巨噬细胞（CFU-GM）的峰值中位数为853/mL（范围96 - 4352；为基础水平的7.6倍）。给予rhG-CSF可提高CFU-GM水平，但无显著差异。使用rhG-CSF时，CFU-GM峰值出现得更早，毒性降低，粒细胞减少持续时间缩短。rhG-CSF组进行的单采次数更少，单次采集的产量更高，患者开始并完成采集计划的速度更快。
VCAD联合方案能够动员MM患者的CPC，推荐将rhG-CSF作为启动方案的基本组成部分。
