Rampling R, Steward W, Paul J, Macham M A, Harvey E, Eckley D
Beatson Oncology Centre, Western Infirmary, Glasgow, UK.
Br J Cancer. 1994 Mar;69(3):541-5. doi: 10.1038/bjc.1994.98.
Nitrosoureas are the drugs most effective in the treatment of patients with intracerebral malignant glioma. Their limiting toxicity is delayed myelosuppression. A prospective, randomised crossover study of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was performed in patients receiving BCNU for relapsed glioblastoma, to investigate whether the resulting haematological toxicity profile could be modified by rhGM-CSF. Adequate data for analysis were obtained in 13 patients. Following BCNU, the nadir neutrophil count was higher in 12 out of 13 patients during the rhGM-CSF-protected cycles compared with the unprotected cycles. The median nadir was also significantly higher (1.79, CI 0.76-3.52, P < 0.005). Five episodes of neutropenia (< 2 x 10(9) l-1) occurred during the unprotected cycles compared with none in the rhGM-CSF-protected cycles (P = 0.076). There was no evidence of any effect on platelets. This result shows that the haematological toxicity profile following therapeutic doses of BCNU can be modified. It suggests that rhGM-CSF and other growth factors should be investigated for clinical efficacy in chemotherapy using nitrosoureas.
亚硝基脲类药物是治疗脑内恶性胶质瘤患者最有效的药物。其局限性毒性是延迟性骨髓抑制。对接受卡莫司汀治疗复发性胶质母细胞瘤的患者进行了一项关于重组人粒细胞-巨噬细胞集落刺激因子（rhGM-CSF）的前瞻性随机交叉研究，以调查rhGM-CSF是否能改变由此产生的血液学毒性特征。13名患者获得了足够的分析数据。使用卡莫司汀后，与未受保护的周期相比，13名患者中有12名在rhGM-CSF保护周期中的中性粒细胞计数最低点更高。中性粒细胞计数最低点的中位数也显著更高（1.79，可信区间0.76 - 3.52，P < 0.005）。在未受保护的周期中发生了5次中性粒细胞减少症（< 2×10⁹/L），而在rhGM-CSF保护周期中未发生（P = 0.076）。没有证据表明对血小板有任何影响。这一结果表明，治疗剂量的卡莫司汀后的血液学毒性特征可以改变。这表明应该研究rhGM-CSF和其他生长因子在使用亚硝基脲类药物化疗中的临床疗效。
