重组人粒细胞集落刺激因子（Filgrastim）在异基因骨髓移植中的应用

APPLICATION OF RECOMBINANT HUMAN GRANULOCYTE COLONY-STIMULATING FACTOR(FILGRASTIM) FOLLOWING ALLOGENEIC BONE MARROW TRANSPLANTATION

重组人粒细胞集落刺激因子（ｒｈＧ－ＣＳＦ，ｆｉｌｇｒａｓｔｉｍ）有促进粒系造血干细胞增殖分化及增强成熟粒细胞功能的作用。本文报告异基因骨髓移植后接受Ｇ－ＣＳＦ治疗的患者共２０例。Ｇ－ＣＳＦ自骨髓移植后ｄ６开始应用，用量为１０ｍｇ·ｋｇ￣（－１）·ｄ￣（－１），连用２０ｄ至连续３ｄ粒细胞＞１．０×１０￣９／ｌ或白细胞＞２．０×１０￣９／ｌ为止。结果表明，粒细胞升至＞０．．５×１０￣９／ｌ及＞１．０×１０￣９／ｌ的平均天数试用组为１３．８及１５．４ｄ；对照组为２１．８及２８．４ｄ（Ｐ＜０．００１）。白细胞升至＞１．０×１０￣９／ｌ及２．０×１０￣９／ｌ的平均天数，试用组为１４．５及１６．３ｄ；对照组为２３．６及３２．３ｄ（Ｐ＜０．００１）。但两组血小板升至＞２０×１０￣９／Ｌ的时间及骨髓移植后输血小板的次数两组无显著差异。骨髓移４植后５ｗｋ内发烧的平均天数试用组每人１．２ｄ；对照组每人４．５ｄ（Ｐ＜０．０１）。作者认为，异基因骨髓移植后应用Ｇ－ＣＳＦ治疗有明显促进粒细胞恢复的作用。且可降低骨髓移植早期的感染率。

The effect of rhG─CSF(filgrastim)was evaluated in 20 patients with leukemia after allogeneic bone marrow transplantation(allo-BMT)with an attempt to accelerate hemopoietic recovery.rhG-CSF was administered at a dosage of 10 mg· kg￣-1·d￣-1 through 4 hours continuous intravenous infusion,starting from day 6 after BMT until 3 consecutive days after the WBC≥2×10￣9/l or neutrophil≥1×10￣9/l.The mean days to reach leukocyte greater than 1.0×10￣9/l and 2.0×10￣9/l were 14.5 and 16.3 days respectively in the filgrastim treated group compared with days 23.6 and 32.3 in the paired control group(P<0.001).The neutrophil recovery to>0.5×10￣9/l and >1.0×10￣9/l was also significantly faster for the patients receiving filgrastim(mean days 13.8 and 15.4)than the control(mean days 21.8 and 28.4)(P<0.001).The total number of febrile episodes within five weeks after BMT was significantly less in the treatment group(23 days in total.mean 1.2 days/cases)compared to that of the controls(90 days in total,mean 4.5 days/case)(P<0.01).No difference was noted in days to reach platelets greater than 20×10￣9/lor the number of platelets infusion between the two groups.No obvious adverse events were noted in all treatment patients.In the treatment group no relapse was observed among 14 cases of acute and chronic myeloid leukemia up to 468 days after filgrastim treatment.It is concluded that filgrastim can significantly accelerate neutrophil and total leukocyte counts after allo-BMT without adverse effect.nor increasing in leukemia relapse.Filgrastim can also decrease the incidence of infections in the early stage after allo-BMT.Filgrastim can therefore make allo-BMT safer.