EFFECT OF GRANULOCYTE COLONY-STIMULATING FACTOR ON NEUTROPENIA AND ASSOCIATED MORBIDITY DUE TO CHEMOTHERAPY FOR TRANSITIONAL-CELL CARCINOMA OF THE UROTHELIUM
EFFECT OF GRANULOCYTE COLONY-STIMULATING FACTOR ON NEUTROPENIA AND ASSOCIATED MORBIDITY DUE TO CHEMOTHERAPY FOR TRANSITIONAL-CELL CARCINOMA OF THE UROTHELIUM
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DOI：
10.1056/nejm198806023182202
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发表时间：
1988-06-02
影响因子：
158.5
通讯作者：
SOUZA, L
中科院分区：
文献类型：
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作者：
GABRILOVE, JL;JAKUBOWSKI, A;SOUZA, L
我们评估了人重组粒细胞集落刺激因子（rhG-CSF）预防化疗诱导的中性粒细胞减少症或加速从这种并发症中恢复的能力，从而使患者能够根据方案设计按时接受全剂量的抗中性粒细胞药物。27名正在接受甲氨蝶呤、阿霉素、长春碱和顺铂治疗的尿路上皮移行细胞癌患者在其联合化疗的第一个周期之前、第一个周期期间或在这两个时间点给予rhG-CSF（最多60 μ g/kg体重/天）。化疗前用rhG-CSF治疗导致中性粒细胞绝对计数呈剂量依赖性增加。化疗后用rhG-CSF治疗显著减少了（91%）每例患者的绝对中性粒细胞计数为1000/微升或更少（P = 0.0039），减少天数（1 vs. 35）使用抗生素治疗发热和中性粒细胞减少症，并显著增加了在治疗周期的第14天有资格接受计划化疗的患者的百分比（100%对29%）（P = 0.0015）。此外，粘膜炎的发生率显著降低（11%对44%，P = 0.041），其严重程度也是如此。这些发现表明rhG-CSF是正常中性粒细胞增殖和成熟的有效刺激物。此外，它的管理可以减少化疗的造血和口服毒性。
We evaluated the ability of human recombinant granulocyte colony-stimulating factor (rhG-CSF) to prevent chemotherapy-induced neutropenia or to accelerate recovery from this complication and thus allow patients to receive full doses of antineoplastic agents on time, according to protocol design. Twenty-seven patients with transitional-cell carcinoma of the urothelium who were undergoing treatment with methotrexate, doxorubicin, vinblastine, and cisplatin were given rhG-CSF (up to 60 .mu.g per kilogram of body weight per day) before their first cycle of combination chemotherapy, during the first cycle, or at both points. Treatment with rhG-CSF before chemotherapy resulted in a dose-dependent increase in the absolute neutrophil count. Treatment with rhG-CSF after chemotherapy significantly reduced the number of days (91 percent) per patient on which the absolute neutrophil count was 1000 per microliter or less (P = 0.0039), reduced the number of days (1 vs. 35) on which antibiotics were used to treat fever and neutropenia, and significantly increased the percentage (100 vs. 29 percent) of patients qualified to receive planned chemotherapy on day 14 of the treatment cycle (P = 0.0015). In addition, the incidence of mucositis was significantly decreased (11 vs. 44 percent, P = 0.041), as was its severity. These findings demonstrate that rhG-CSF is a potent stimulus of normal neutrophil proliferation and maturation. In addition, its administration can reduce both the hematopoietic and oral toxicity of chemotherapy.