Jakacki R I, Jamison C, Mathews V P, Heilman D K, Dropcho E, Cornetta K, Macdonald D R, Williams D A
Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202-5225, USA.
Med Pediatr Oncol. 1998 Dec;31(6):483-90. doi: 10.1002/(sici)1096-911x(199812)31:6<483::aid-mpo4>3.0.co;2-9.
The regimen of procarbazine, CCNU, and vincristine is active against gliomas. Previous attempts at dose-intensification have been unsuccessful because of delayed and cumulative myelosuppression. We sought to determine whether peripheral blood stem cell (PBSC) infusions would allow dose-escalation and time compression.
Eleven patients, age 2.8-35.9 years, with newly diagnosed (n = 10) or recurrent (n = 1) gliomas underwent PBSC harvesting after mobilization with G-CSF. Chemotherapy consisted of CCNU 130 mg/m2 on day 0, vincristine 1.5 mg/m2 on days 0 and 7, and procarbazine 150 mg/m2 on days 1-7. PBSCs were reinfused on day 9 of each course. Four courses of chemotherapy were administered 28 days apart or when counts recovered. Involved field radiation was administered to newly diagnosed high-grade glioma patients following recovery from chemotherapy.
Compared to the standard PCV regimen given every 6 weeks, dose intensity received was 1.7- and 1.8-fold greater for CCNU and procarbazine. Chemotherapy was delivered on time in 33/41 (80.5%) courses. Four courses (9.8%) were complicated by absolute neutrophil counts < 200/microL; platelet nadirs < 50,000/microL occurred in two courses (4.9%). Fever with neutropenia complicated three courses. Eight of 9 patients with measurable disease had an objective decrease in tumor size and/or decreased enhancement. Median survival for patients with high-grade gliomas (n = 6) was 13 months.
Dose-intensification of PCV is possible using PBSCs.
丙卡巴肼、洛莫司汀和长春新碱方案对胶质瘤有效。先前尝试剂量强化因延迟和累积骨髓抑制而未成功。我们试图确定外周血干细胞（PBSC）输注是否能实现剂量递增和时间压缩。
11例年龄在2.8 - 35.9岁之间的新诊断（n = 10）或复发（n = 1）胶质瘤患者在使用G - CSF动员后进行PBSC采集。化疗方案为第0天给予洛莫司汀130mg/m²，第0天和第7天给予长春新碱1.5mg/m²，第1 - 7天给予丙卡巴肼150mg/m²。每个疗程的第9天回输PBSC。每28天或计数恢复时给予四个疗程的化疗。新诊断的高级别胶质瘤患者化疗恢复后接受受累野放疗。
与每6周给予的标准PCV方案相比，洛莫司汀和丙卡巴肼的剂量强度分别提高了1.7倍和1.8倍。41个疗程中有33个（80.5%）按时进行了化疗。四个疗程（9.8%）出现绝对中性粒细胞计数<200/μL的并发症；两个疗程（4.9%）出现血小板最低点<50,000/μL。发热伴中性粒细胞减少使三个疗程复杂化。9例可测量疾病患者中有8例肿瘤大小客观减小和/或强化降低。高级别胶质瘤患者（n = 6）的中位生存期为13个月。
使用PBSC可以实现PCV方案的剂量强化。
