Bartzsch O, Riepl M, Busch M, Michael G, Allgäuer M, Voss A C, Sauer R, Dühmke E, Gademann G, Molls M
Strahlenther Onkol. 1998 Nov;174(11):551-5. doi: 10.1007/BF03038291.
Therapy-induced leukopenias with corresponding consequences repeatedly occur in radiotherapy using combined modalities treatment. In radiotherapy, where G-CSF (granulocyte-colony-stimulating-factor) is not licensed, G-CSF has been used successfully under individual circumstances. These results were confirmed in several studies with small patient groups. The aim of this study was to check former results in a larger patient group, to verify postulated side effects and specially to define a cost-effective schedule in the treatment with G-CSF (Neupogen).
In this surveillance trial 50, partially previously treated patients with different malignant tumors were treated with G-CSF. According to the probability of a leucocytosis lower than 1000/mm3, G-CSF (Neuropogen) was already given at leukocyte values lower than 2500/mm3 (500/mm3 bis 2450/mm3). It administered subcutaneously every other day, based on body weight until reaching normal leucocyte levels.
In 92% of the patients the increase of leucocytes occurred in the first 24 hours. On average G-CSF was given 4.9 times per patient. Patients without prior therapies or less complex therapies needed less G-CSF applications (3.5 to 5.8 applications). Due to individually varying leucocyte courses the G-CSF therapy was started with leucocyte values between 500/mm3 and 2450/mm3. Patients who were treated with up to 3 G-CSF applications had higher leucocyte levels than those with 4 or more applications (1620/mm3 to 1250/mm3). Leucopenia related infections, therapy interruptions or break-offs did not occur. Besides light "flu like" symptoms in 14% of the patients, no side effects were observed.
When a decrease of leucocyte values lower than 1000/mm3 is expected, the most cost-effective treatment is given when starting the interventional G-CSF administration already at leucocyte values around 1600/mm3. Leucopenias can be treated effectively, with little side effects and in a cost-effective way when G-CSF is given on time.
在联合治疗的放射治疗中，治疗引起的白细胞减少及其相应后果反复出现。在未批准使用G-CSF（粒细胞集落刺激因子）的放射治疗中，G-CSF已在个别情况下成功使用。这些结果在几项小患者群体的研究中得到了证实。本研究的目的是在更大的患者群体中验证先前的结果，核实假定的副作用，并特别确定使用G-CSF（优保津）治疗的具有成本效益的方案。
在这项监测试验中，50例部分先前接受过治疗的不同恶性肿瘤患者接受了G-CSF治疗。根据白细胞计数低于1000/mm³的可能性，当白细胞值低于2500/mm³（500/mm³至2450/mm³）时即给予G-CSF（优保津）。根据体重每隔一天皮下注射一次，直至白细胞水平恢复正常。
92%的患者在最初24小时内白细胞计数增加。每位患者平均使用G-CSF 4.9次。未接受过先前治疗或治疗复杂性较低的患者所需的G-CSF应用次数较少（3.5至5.8次）。由于白细胞变化过程个体差异，G-CSF治疗在白细胞值500/mm³至2450/mm³之间开始。接受3次及以下G-CSF应用治疗的患者白细胞水平高于接受4次及以上应用治疗的患者（1620/mm³至1250/mm³）。未发生与白细胞减少相关的感染、治疗中断或中止。除14%的患者出现轻微的“流感样”症状外，未观察到其他副作用。
当预计白细胞值降至低于1000/mm³时，在白细胞值约为1600/mm³时开始进行干预性G-CSF给药是最具成本效益的治疗方法。当及时给予G-CSF时，白细胞减少症可得到有效治疗，副作用小且具有成本效益。
