Hansen P B, Johnsen H E, Ralfkiaer E, Hansen N E
Department of Internal Medicine and Haematology L, Herlev Hospital, University of Copenhagen, Denmark.
Br J Haematol. 1993 Aug;84(4):581-5. doi: 10.1111/j.1365-2141.1993.tb03131.x.
The grade of neutropenia after chemotherapy seems to be correlated to the bone marrow cellularity as judged by biopsies. Prolonged blood neutropenia after sequential chemotherapy reduces dose intensity and increases the risk of severe infections. A predictive non-invasive test for marrow cellularity is needed in the attempt to predict chemotherapy-induced blood neutropenia. Thirty-one patients with haematological disorders were studied with measurements of blood absolute neutrophil counts (ANC) 24 h after a single subcutaneous injection of recombinant human granulocyte colony stimulating factor (rhG-CSF) or granulocyte-macrophage CSF (rhGM-CSF). Before cytokine administration all patients had bone marrow biopsies performed. The median increase in blood ANC 24 h after cytokine administration was 15.9 x 10(9)/l (range 3.7-34.2) in 18 patients with normo- or hypercellular marrows and only 0.4 x 10(9)/l (range 0.0-11.2) in 13 patients with hypocellular marrows (P < 0.00001). An increase in ANC or more than 5 x 10(9)/l was predictive for normo- or hypercellular bone marrows with a sensitivity and specificity of 94% and 84%, respectively. A subsequent pilot study in selected patients with prolonged neutropenia was performed. The ANC increment in 12 cases before chemotherapy correlated to the grade of neutropenia and may predict the risk of febrile neutropenia. It is suggested that blood responsiveness to myeloid growth factors correlates with marrow cellularity and may identify outpatients with risk for severe neutropenia after cyclic chemotherapy.
化疗后中性粒细胞减少的程度似乎与骨髓活检判断的骨髓细胞密度相关。序贯化疗后长时间的血液中性粒细胞减少会降低剂量强度并增加严重感染的风险。为了预测化疗引起的血液中性粒细胞减少，需要一种预测骨髓细胞密度的非侵入性检测方法。对31例血液系统疾病患者进行了研究，在单次皮下注射重组人粒细胞集落刺激因子（rhG-CSF）或粒细胞-巨噬细胞集落刺激因子（rhGM-CSF）后24小时测量血液绝对中性粒细胞计数（ANC）。在给予细胞因子之前，所有患者均进行了骨髓活检。18例骨髓细胞密度正常或增高的患者在给予细胞因子后24小时血液ANC的中位数增加为15.9×10⁹/L（范围3.7 - 34.2），而13例骨髓细胞密度减低的患者仅为0.4×10⁹/L（范围0.0 - 11.2）（P < 0.00001）。ANC增加超过5×10⁹/L可预测骨髓细胞密度正常或增高，敏感性和特异性分别为94%和84%。随后对选定的中性粒细胞减少持续时间较长的患者进行了一项初步研究。12例患者化疗前的ANC增量与中性粒细胞减少的程度相关，并且可能预测发热性中性粒细胞减少的风险。提示血液对髓系生长因子的反应性与骨髓细胞密度相关，并且可能识别出接受周期化疗后有严重中性粒细胞减少风险的门诊患者。
