Gustavsson A
Department of Oncology, University Hospital, Lund, Sweden.
Acta Oncol. 1997;36(5):483-8. doi: 10.3109/02841869709001303.
The main objective of this study was to assess to what extent filgrastim (G-CSF, Amgen-Roche) can facilitate administration of the full dose intensity of MOPP/ABVD chemotherapy to patients with Hodgkin's disease. Sixteen patients with Hodgkin's disease were treated with MOPP/ABVD and filgrastim support between January 1992 and March 1994. Twenty-five patients treated with MOPP/ABVD 1987-1991 served as historical controls. The two groups were well matched for age, gender, stage, performance status and histological subgroups, but in the study group more patients had B-symptoms (p < 0.05). Dose intensity (DI) was calculated in mg/m2/week and the intended average dose was designated as 1. The planned average DI was reached by 8/16 patients in the study group but by only 1/25 in the control group (p < 0.001). The reasons for decreased DI in the study group were neutropenia (n = 5), thrombocytopenia (2 pts) and neurotoxicity (n = 1). In the control group the reason for decreased DI was neutropenia (n = 24). In the study group 15/16 patients achieved Complete Response (CR), 2/15 relapsed and 15/16 were surviving after a median follow-up 31 (6-48) months. In the control group 25/25 patients attained CR, 5/25 relapsed and 20/25 were surviving after a median follow up 67 (12-100) months. No severe toxicity was observed during filgrastim therapy. To conclude, the dose intensity during MOPP/ABVD therapy was significantly higher if filgrastim was administered, but the additional benefit that this confers remains to be determined. A large scale, retrospective analyses of treatment response and actual dose-intensity should help answer this question and give guidance as to if and when hematopoietic growth factors should be administered to patients with Hodgkin's disease.
本研究的主要目的是评估非格司亭（粒细胞集落刺激因子，安进 - 罗氏公司生产）在多大程度上能够帮助霍奇金病患者接受足剂量强度的MOPP/ABVD化疗。1992年1月至1994年3月期间，16例霍奇金病患者接受了MOPP/ABVD化疗及非格司亭支持治疗。1987 - 1991年期间接受MOPP/ABVD治疗的25例患者作为历史对照。两组在年龄、性别、分期、体能状态和组织学亚组方面匹配良好，但研究组中有更多患者出现B症状（p < 0.05）。剂量强度（DI）以mg/m²/周计算，预期平均剂量设定为1。研究组中8/16的患者达到了计划的平均DI，而对照组中只有1/25的患者达到（p < 0.001）。研究组中DI降低的原因是中性粒细胞减少（n = 5）、血小板减少（2例）和神经毒性（n = 1）。对照组中DI降低的原因是中性粒细胞减少（n = 24）。研究组中15/16的患者获得完全缓解（CR），2/15复发，15/16在中位随访31（6 - 48）个月后仍存活。对照组中25/25的患者达到CR，5/25复发，20/25在中位随访67（12 - 100）个月后仍存活。在非格司亭治疗期间未观察到严重毒性。总之，使用非格司亭时MOPP/ABVD治疗期间的剂量强度显著更高，但这种做法带来的额外益处仍有待确定。对治疗反应和实际剂量强度进行大规模回顾性分析应有助于回答这个问题，并为是否以及何时应给霍奇金病患者使用造血生长因子提供指导。
