Chen S H, Liang D C, Liu H C
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Am J Hematol. 1998 May;58(1):20-3. doi: 10.1002/(sici)1096-8652(199805)58:1<20::aid-ajh4>3.0.co;2-2.
We sought to determine the role of granulocyte colony-stimulating factor (G-CSF) as an adjunct therapy in high-dose cytarabine-containing chemotherapy (HD C/T) for children with acute leukemia. Seventeen patients, aged 9 months to 18 years old, 8 ALL and 9 AML, were treated with cytarabine (Ara-C) 1 g/m2 q12h for 8 doses with mitoxantrone, idarubicin, VP-16, or asparaginase. A total of 71 courses of HD C/T was given. G-CSF was not used in 14 courses (Group A). Prophylactic G-CSF was given in 57 courses (Group B) as 200 microg/m2/d SC started one day after the completion of HD C/T and continued until the neutrophil recovery was maintained. The incidences of sepsis per course in Group A and Group B were 35.7% (5/14) and 40.4% (23/57), respectively. While 2 patients in Group A died of sepsis or pneumonia, none in Group B died. The mortality and delay in chemotherapy were fewer in Group B (P = 0.037 and 0.0006, respectively, Fisher exact test). There was a shorter average number of days of neutrophil <500/cumm, antibiotic usage, fever, and hospital stay in Group B (11, 8, 5, 17 days in Group B vs. 21, 17, 10, 37 days in Group A; P = 0.0001, log-rank test; 0.0006, 0.0023, 0.0001, Wilcoxon rank sum test, respectively). The incidence of neutropenic fever was lower in Group B, but the difference did not reach statistical significance (P = 0.06, Fisher exact test). We conclude that G-CSF as an adjunct therapy in HD C/T is effective in reducing mortality, days of neutropenia, antibiotic usage, fever, hospital stay, and frequency of delay in chemotherapy. The efficacy of this treatment approach requires further testing in a randomized, controlled trial.
我们试图确定粒细胞集落刺激因子（G-CSF）作为辅助治疗在含大剂量阿糖胞苷化疗（HD C/T）中对急性白血病患儿的作用。17例年龄在9个月至18岁之间的患者，其中8例为急性淋巴细胞白血病（ALL），9例为急性髓细胞白血病（AML），接受了阿糖胞苷（Ara-C）1 g/m²，每12小时一次，共8剂，并联合米托蒽醌、伊达比星、VP-16或天冬酰胺酶治疗。共进行了71个疗程的HD C/T。14个疗程未使用G-CSF（A组）。57个疗程给予预防性G-CSF（B组），剂量为200μg/m²/天，皮下注射，在HD C/T结束后一天开始，持续至中性粒细胞恢复并维持。A组和B组每个疗程的败血症发生率分别为35.7%（5/14）和40.4%（23/57）。A组有2例患者死于败血症或肺炎，B组无死亡病例。B组的死亡率和化疗延迟较少（分别为P = 0.037和0.0006，Fisher精确检验）。B组中性粒细胞<500/立方毫米的平均天数、抗生素使用天数、发热天数和住院天数较短（B组分别为11天、8天、5天、17天，A组分别为21天、17天、10天、37天；P = 0.0001，对数秩检验；P = 0.0006、0.0023、0.0001，分别为Wilcoxon秩和检验）。B组中性粒细胞减少性发热的发生率较低，但差异未达到统计学意义（P = 0.06，Fisher精确检验）。我们得出结论，G-CSF作为HD C/T的辅助治疗可有效降低死亡率、中性粒细胞减少天数、抗生素使用天数、发热天数、住院天数和化疗延迟频率。这种治疗方法的疗效需要在随机对照试验中进一步验证。
