重组人粒细胞集落刺激因子促进自体造血干细胞移植后造血功能恢复的临床研究

A Clinical Study of rhG CSF in Accelerating Hematological Recovery Following Autologous Hematopoietic Stem Cells Transplantation

背景与目的:高剂量化放疗联合自体造血干细胞移植(autologoushematopoieticstemcellstransplantation,AHSCT)能够提高某些实体瘤的疗效,该疗法的成功得益于重组人粒细胞集落刺激因子(recombinanthumangranulocytecolony-stimulatingfactor,rhG-CSF)的运用。本研究的目的是观察rhG-CSF对实体瘤患者自体造血干细胞移植后造血功能重建的影响。方法:将接受AHSCT的130例实体瘤患者分为rhG-CSF组和对照组,rhG-CSF组在造血干细胞回输后第6天开始连日给予rhG-CSF250～300μg/d,皮下注射,直至白细胞(whitebloodcell,WBC)≥5.0×109/L为止;对照组在造血干细胞回输后不给予rhG-CSF。结果:130例患者共完成移植132次,其中2例为2次移植。研究早期的24例患者采取自体骨髓移植,其中12例移植后给予rhG-CSF;此后的106例均采用自体外周血造血干细胞移植(2例为2次移植),其中47例移植后给予rhG-CSF。(1)rhG-CSF组和对照组自体骨髓移植患者住无菌病房的中位时间为33天和41天,WBC恢复到1.5×109/L以上的中位时间为14天和24天,两组之间的差异有显著性(P<0.05);两组血小板(platelet,PLT)恢复到20×109/L及50×109/L以上的中位时间均无显著性差异。(2)rhG-CSF组和对照组自体外周血干细胞移植患者住无菌病房的中位时间为17天和20天,

BACKGROUND &OBJECTIVE: High dose chemotherapy and radiotherapy supported by autologous hematopoietic stem cells transplantation(AHSCT) can improve the efficacy of some malignant solid tumors. Successful AHSCT should owe to rational usage of recombinant human granulocyte colony stimulating factor (rhG CSF) in some extent. The purpose of this study was to observe the role of rhG CSF in hematological recovery after AHSCT for patients with solid tumors. METHODS: A total of 130 patients with solid tumors were divided into two groups. The rhG CSF group received rhG CSF at the dose of 250-300 μg daily from day 6 until WBC recovering to 5.0×109/L. The control group did not receive rhG CSF after AHSCT. RESULTS: A total of 132 person times AHSCT were finished and 2 patients of them experienced twice transplantation. Twenty four patients received autologous bone marrow transplantation (ABMT), 12 of them received rhG CSF following AHSCT and the others did not. One hundred and six persons underwent autologous peripheral blood stem cells transplantation (APBSCT), 47 patients received rhG CSF and 61 did not. (1)In rhG CSF group and control group of ABMT,the median days of WBC up to 5.0×109/L were 14 days and 24 days (P< 0 001),respectively. The median time of hospitalization was 33 days and 41 days (P< 0 05),respectively. There was no statistical difference in median time of PLT recovering to 20×109/L and 50×109/L in the two groups.(2)In rhG CSF group and control group of APBSCT,the median time of WBC recovering to 5 0×109/L were 10 days and 13 days (P< 0.01), respectively. The median time of hospitalization was 17 days and 20 days(P< 0.01),respectively.There was no significantly statistical difference in median time of PLT recovering to 50×109/L in the two groups. (3)The frequency of infectious complication was no statistical difference between two groups (P=0 45). CONCLUSION: rhG CSF administration after AHSCT can obviously accelerate the recovery of WBC and shorten the time of hospitalization, but there is no significant effect on the recovery of PLT. Further study is needed to investigate whether rhG CSF can reduce the infectious complication.