Johnston E M, Crawford J
Duke University Medical School, Durham, NC 27710, USA.
Semin Oncol. 1998 Oct;25(5):552-61.
Neutropenia is the most common dose-limiting toxicity of conventional chemotherapy. The colony-stimulating factors (CSFs), granulocyte (G)-CSF and granulocyte-macrophage (GM)-CSF, stimulate proliferation and maturation of myeloid progenitors and have been effective in reducing neutropenia and its complications. The primary use of CSFs in patients receiving chemotherapy for small cell lung cancer has resulted in a reduction in the incidence of febrile neutropenia, a decrease in the duration of grade IV neutropenia, and a reduction in hospitalization time and antibiotic use. Although CSF use allows for higher dose intensity, a survival benefit has not been proven. The use of CSFs after the occurrence of neutropenic fever decreases the duration of grade IV neutropenia, but effects on hospitalization and antibiotic use are less well-defined. The therapeutic use of CSFs in the setting of established neutropenia, regardless of the presence or absence of fever, is not supported in the literature. The administration of CSFs to patients with acute myeloid leukemia is safe in that no trial has demonstrated evidence of leukemic stimulation with these drugs. As in other settings, the duration of neutropenia is shortened if CSFs are used postchemotherapy with evidence of clinical benefit. CSFs also decrease chemotherapeutic toxicity via other mechanisms. The use of G-CSF reduces the incidence of mucositis, in normal donors enhances the yield of leukapheresis for granulocyte transfusion, and is beneficial in the autologous transplant setting. These effects of CSFs in mitigating chemotherapeutic toxicity are reviewed.
中性粒细胞减少是传统化疗最常见的剂量限制性毒性。集落刺激因子（CSF），即粒细胞（G）-CSF和粒细胞-巨噬细胞（GM）-CSF，可刺激髓系祖细胞的增殖和成熟，并已有效减少中性粒细胞减少及其并发症。CSF在接受小细胞肺癌化疗的患者中的主要应用已使发热性中性粒细胞减少的发生率降低，IV级中性粒细胞减少的持续时间缩短，住院时间和抗生素使用减少。尽管使用CSF可实现更高的剂量强度，但尚未证实其对生存有益。在中性粒细胞减少性发热发生后使用CSF可缩短IV级中性粒细胞减少的持续时间，但对住院和抗生素使用的影响尚不太明确。在已确诊的中性粒细胞减少情况下，无论有无发热，CSF的治疗性使用在文献中均未得到支持。对急性髓系白血病患者使用CSF是安全的，因为没有试验证明这些药物有白血病刺激的证据。与其他情况一样，如果在化疗后使用CSF且有临床获益证据，则中性粒细胞减少的持续时间会缩短。CSF还通过其他机制降低化疗毒性。使用G-CSF可降低粘膜炎的发生率，在正常供体中可提高用于粒细胞输注的白细胞单采产量，并且在自体移植情况下有益。本文综述了CSF在减轻化疗毒性方面的这些作用。
