Cyclophosphamide, doxorubicin, vincristine, prednisone dose intensification with granulocyte colony-stimulating factor markedly depletes stem cell reserve for autologous bone marrow transplantation
Cyclophosphamide, doxorubicin, vincristine, prednisone dose intensification with granulocyte colony-stimulating factor markedly depletes stem cell reserve for autologous bone marrow transplantation
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DOI：
10.1182/blood.v90.12.4996.4996_4996_5001
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发表时间：
1997-12-15
期刊：
影响因子：
20.3
通讯作者：
Nadler, L
中科院分区：
文献类型：
--
作者：
Freedman, A;Neuberg, D;Nadler, L
造血生长因子允许化疗剂量递增。这种方法可能会降低造血干细胞的质量和数量。剂量强化后恢复的干细胞支持清髓性治疗的能力尚不清楚。在既往未经治疗的晚期滤泡性淋巴瘤患者中，在两项诱导治疗（标准剂量环磷酰胺、多柔比星、长春新碱）的序贯试验中比较了三系造血移植。泼尼松[CHOP]无生长因子或剂量强化CHOP支持的粒细胞集落刺激因子[G-CSF]），随后是相同的清髓性治疗和自体干细胞支持。在干细胞再输注后第100、180和360天比较神经元、血小板和红细胞（RBC）植入。尽管患者特征相似，包括骨髓单个核细胞数量相当的回输，但干细胞移植后。与标准剂量CHOP相比，在接受高剂量CHOP和G-CSF的患者中观察到中性粒细胞和血小板植入的高度显著的延长。这些发现表明，剂量强化化疗和G-CSF招募干细胞进入增殖期，并且G-CSF允许在干细胞易受细胞毒性治疗损伤时进行再治疗。清髓性治疗后这种血液学移植不足的情况可以通过缩短给予生长因子支持的时间、延长周期之间的间隔或尝试从骨髓或外周血中重复收获额外的干细胞来避免。因此，如果干细胞用于支持清髓性治疗，则必须谨慎使用生长因子支持的强化化疗。(C)1997年，美国血液学会。
Hematopoietic growth factors allow dose escalation of chemotherapy. This approach may potentially reduce the quality and quantity of hematopoietic stem cells. The capacity of stem cells recovered after dose intensification to support myeloablative therapy is unknown. In patients with previously untreated advanced follicular lymphoma, trilineage hematopoietic engraftment was compared in two sequential trials of induction therapy (standard dose cyclophosphamide, doxorubicin, vincristine. prednisone [CHOP] without growth factors or dose intensification CHOP supported by granulocyte colony-stimulating factor [G-CSF]) followed by identical myeloablative therapy and autologous stem cell support. Neutrophil, platelet, and red blood cell (RBC) engraftment were compared on days 100, 180, and 360 after stem cell reinfusion. Despite similar patient characteristics including reinfusion of comparable numbers of marrow mononuclear cells, after stem cell transplantation. a highly significant prolongation of neutrophil and platelet engraftment was seen in patients who received high dose CHOP and G-CSF in comparison to standard dose CHOP. These findings suggest that dose intensified chemotherapy and G-CSF recruited stem cells into a proliferative phase and that G-CSF allowed retreatment at a time when stem cells were susceptible to damage by cytotoxic therapy. Such inadequate hematologic engraftment after myeloablative therapy might be avoided by either shortening the time that growth factor support is administered, lengthening the interval between cycles, or attempting to repetitively harvest additional stem cells either from the marrow or peripheral blood. Therefore, intensification of chemotherapy with growth factor support must be used with caution if stem cells are to be used to support myeloablative therapy. (C) 1997 by The American Society of Hematology.