Optimal Timing (Preemptive versus Supportive) of Granulocyte Colony-Stimulating Factor Administration following High-Dose Cyclophosphamide
Optimal Timing (Preemptive versus Supportive) of Granulocyte Colony-Stimulating Factor Administration following High-Dose Cyclophosphamide
复制标题
高剂量环磷酰胺后粒细胞集落刺激因子给药的最佳时机（先发性与支持性）
作者：
G. Koumakis;M. Vassilomanolakis;V. Barbounis;E. Hatzichristou;S. Demiri;G. Plataniotis;F. Pamouktsoglou;A. Efremidis
目的：本研究的目的是比较粒细胞集落刺激因子（G-CSF）治疗的各种时间表在接受大剂量环磷酰胺的患者的临床模型（HDCY 45 g/m2）治疗潜在恶性肿瘤，以研究最佳时间根据血细胞减少症的发生率和持续时间以及相关参数（如发热事件的发生率、抗生素使用、G-CSF给药的持续时间和成本以及所使用的各种方案的总体临床益处和成本效益。患者和方法：72个疗程的序贯队列研究。化疗后24、48、72、96 h（预先治疗）或白细胞减少症（WBC ≤ 1，000/µl）发作时（支持治疗）给予G-CSF。研究参数进行了比较，在不同的群体，以及对照组谁收到HDCY没有G-CSF的支持。结果如下：（1）早期（24、48 h）接受G-CSF治疗的患者，白细胞减少症（WBC ≤ 1，000/µl）的持续时间短于晚期（72、96 h）接受G-CSF治疗或作为支持治疗的患者（p < 0.05）。然而，中性粒细胞减少症（ANC ≤500/µl）或血小板减少症（血小板≤ 20，000/µl）的持续时间不受不同治疗时间表的影响。(2)与晚期治疗组（>96小时）、支持组和对照组相比，早期接受G-CSF治疗（最多72小时）的患者具有较少的伴中性粒细胞减少的发热天数（p < 0.05）。抗生素费用也有利于早期治疗组。延迟（>72小时）治疗组的发热天数中位数和抗生素费用与未接受G-CSF治疗的患者相似。(3)当预先给予G-CSF时，与支持组和对照组相比，达到正常WBC（5，000/µl）所需的时间更短。这是由于WBC恢复时间延长，而不是白细胞减少症的早期发作（尾部效应）。当G-CSF给药延迟时，发生延迟的白细胞减少症恢复。(4)因此，与晚期（>72小时）和支持组相比，早期治疗组达到正常WBC（5，000/µl）所需的G-CSF治疗时间较短，并且该组使用G-CSF的成本较低，这表明成本增加，但与对照组相比无临床获益。结论：HDCY后给予G-CSF对严重白细胞减少症和血小板减少症的发生率和持续时间具有相似的影响。然而，严重的白细胞减少症是较短的，当G-CSF开始长达72小时后HDCY。G-CSF给药的时间和费用也有利于早期开始治疗，以及发热天数和抗生素使用。与早期组相比，延迟（>72小时）或支持性治疗表明更多的发热事件，抗生素使用和更高的费用。在这项研究中，晚期（>72小时）或支持性G-CSF给药表明与不治疗相比，在白细胞减少症的持续时间、发热天数、抗生素使用和总治疗费用方面没有获益。
Purpose: The aim of this study is to compare various time schedules of granulocyte colony-stimulating factor (G-CSF) treatment in a clinical model of patients who received high-dose cyclophosphamide (HDCY 45 g/m2) for the treatment of an underlying malignancy in order to investigate the optimal time (preemptive vs. supportive) of G-CSF initiation upon the incidence and duration of cytopenias and related parameters, such as incidence of febrile episodes, antibiotic use, duration and cost of G-CSF administration and overall clinical benefit and cost effectiveness of various schedules used. Patients and Methods: Seventy-two courses were given in a sequential cohort study. G-CSF was administered either 24, 48, 72, 96 h after chemotherapy (preemptive treatment) or upon the onset of leukopenia (WBC ≤1,000/µl) (supportive treatment). Study parameters were compared among the various groups as well as to a control group who received HDCY without G-CSF support. Results: (1) Patients who received G-CSF early (24, 48 h) had a shorter duration of leukopenia (WBC ≤1,000/µl) compared to those who received G-CSF at a later stage (72, 96 h) or as supportive treatment (p < 0.05). However the duration of neutropenia (ANC ≤500/µl) or thrombocytopenia (platelets ≤20,000/µl) was not affected by the different time schedules of treatment. (2) Patients who received G-CSF early (up to 72 h) had less febrile days with neutropenia in comparison to late treatment (>96 h), supportive and control groups (p < 0.05). The cost of antibiotics was also in favor of the early treatment group. The median duration of febrile days of the delayed (>72 h) treatment groups and antibiotic cost was similar to those in patients who did not receive G-CSF at all. (3) When G-CSF was given preemptively a shorter time was required to reach normal WBC (5,000/µl) in comparison to the sup- portive and control group. This was due to a prolonged WBC recovery rather than to an early onset of leukopenia (tail effect). A delayed leukopenia recovery occurs as administration of G-CSF is delayed. (4) As a result the required length of G-CSF treatment to reach normal WBC (5,000/µl) was shorter in the early treatment group and the cost from G-CSF use was less in that group in comparison to the late (>72 h) and supportive groups which indicated an increased cost without clinical benefit over controls. Conclusions: G-CSF administration after HDCY has a similar effect upon the incidence and duration of severe leukopenia and thrombocytopenia. However, severe leukopenia is shorter when G-CSF starts up to 72 h after HDCY. The length of G-CSF administration and its cost is also in favor of early initiation of treatment as well as the number of febrile days and antibiotic use. Delayed (>72 h) or supportive treatment indicate more febrile episodes, antibiotic use and higher cost when compared to the early groups. Late (>72 h) or supportive G-CSF administration in this study indicates no benefit versus no treatment in relation to length of leukopenia, febrile days, antibiotic use and overall treatment cost.
重组人粒细胞集落刺激因子对灵长类自体骨髓移植后造血重建的影响。
影响因子：
0.9
作者：
Gillio,AP;Bonilla,MA;Potter,GK;Gabrilove,JL;O'Reilly,RJ;Souza,LM;Welte,K
通讯作者：
Welte,K
影响因子：
56.9
作者：
SOUZA, LM;BOONE, TC;WELTE, K
通讯作者：
WELTE, K
集落刺激因子和宿主防御。
影响因子：
39.2
作者：
Weisbart,RH;Gasson,JC;Golde,DW
通讯作者：
Golde,DW