Kannuki S, Bando K, Shirakawa N, Matsumoto K, Takaue Y, Kuroda Y
Department of Neurological Surgery, School of Medicine, University of Tokushima.
No Shinkei Geka. 1995 May;23(5):411-5.
In this study, the newly developed marrow-rescue therapy during myelosuppression is utilized. In this therapy, peripheral blood stem cell transfusion (PBSCT) is administered following high-dose chemotherapy. Harvest of peripheral blood stem cells (PBSC) during myelosuppression following marrow-ablative chemotherapy is a safe, reliable procedure in children with leukemia. And administration of these cryopreserved PBSC is useful in reducing myelosuppression following intensive/ultra high-dose chemotherapy. In this study, several courses of intensive chemotherapy (1 course: VP-16 300mg/m2 x 5 days + carboplatin 400-500mg/m2 x 3 days) and one course of ultra-high dose chemotherapy (1 course: VP-16 400mg/m2 x 8 days + carboplatin 800mg/m2 x 5 days + MCNU 250, 200mg/m2 x each day) with PBSC transfusion were applied in four cases of pediatric malignant brain tumors (2 cases of medulloblastoma, one case of pineoblastoma and anaplastic ependymoma) after surgical reduction. With PBSC transfusion, myelosuppression following high-dose chemotherapy could be overcome without serious complication in all cases. Three cases showed complete remission and one showed partial remission after the operation and intensive chemotherapy. However, CSF dissemination appeared in two cases and they died 20 and 28 months after the onset respectively. Intensive/ultra high-dose chemotherapy with PBSC transfusion is a safe procedure in children with malignant brain tumors. This procedure may enable the postponement of radiation for pediatric malignant brain tumor cases under three years of age.
在本研究中，采用了新开发的骨髓抑制期骨髓挽救疗法。在该疗法中，大剂量化疗后进行外周血干细胞输注（PBSCT）。对于白血病患儿，在清髓性化疗后的骨髓抑制期采集外周血干细胞（PBSC）是一种安全、可靠的方法。输注这些冷冻保存的PBSC有助于减轻强化/超高剂量化疗后的骨髓抑制。在本研究中，对4例小儿恶性脑肿瘤（2例髓母细胞瘤、1例松果体母细胞瘤和间变性室管膜瘤）患儿在手术切除后应用了几个疗程的强化化疗（1个疗程：依托泊苷300mg/m²×5天+卡铂400 - 500mg/m²×3天）和1个疗程的超高剂量化疗（1个疗程：依托泊苷400mg/m²×8天+卡铂800mg/m²×5天+司莫司汀250、200mg/m²×每天）并进行PBSC输注。通过PBSC输注，所有病例均能克服大剂量化疗后的骨髓抑制且无严重并发症。3例患儿术后及强化化疗后完全缓解，1例部分缓解。然而，2例患儿出现脑脊液播散，分别在发病后20个月和28个月死亡。对于小儿恶性脑肿瘤患儿，强化/超高剂量化疗联合PBSC输注是一种安全的方法。该方法可能使3岁以下小儿恶性脑肿瘤病例推迟放疗。
