Abstract Objective combined with G CSF and GM CSF treatment Ⅱ degree and the feasibility and safety of more chemotherapy, bone marrow suppression, and adverse reactions. Methods 84 patients diagnosed malignancy after chemotherapy in patients with Ⅱ degree and above, bone marrow suppression, randomized single blind into G CSF group (G group: n = 28, G CSF 150 μg / d subcutaneous injection), GM-CSF group (GM group: n = 28, GM-CSF 150 μg / d subcutaneous injection), the combined treatment group (G / GM group: n = 28, G CSF 75 μg / d and GM CSF 75 μg / d subcutaneous injection ). Observed: (1) with CSF WBC restore the normal number of days required; (2) disable CSF 48h after WBC count; (3) disable CSF48h PLT count; (4) the incidence of adverse reactions. Results of the three groups of patients after treatment can effectively increase the white blood cells. Normal number of days on the GM group was significantly longer than that of group G and G / GM group (P <0.05); withdrawal 48h WBC count after the GM group and G / GM group was significantly higher than the G group (P <0.05); disable CSF WBC recovery PLT count 48 h after the GM group and G / GM group was significantly higher than the G group (P <0.05). The three groups of incidence of adverse reactions similar groups showed no significant difference. Conclusion G CSF and GM CSF combination is safe, effective treatment of chemotherapy, bone marrow suppression, can avoid a separate medication abuse is an effective treatment for bone marrow suppression after chemotherapy.
Key words】 colony-stimulating factor; chemotherapy; combination therapy; bone marrow suppression
The emergence of combination chemotherapy, bone marrow suppression chemotherapy drug that hinders chemotherapy key to the continuity of the colony-stimulating factor (Colony stimulating factor, CSF), bone marrow suppression after chemotherapy with good treatment. Generally think, granulocyte colony-stimulating factor G CSF (Granulocyte “colony" stimulating factor) and granulocyte / single cell set off the stimulus factor GM CSF (Granulocyte macrophage “colony" stimulating factor) the role of the position is different, synergies, the joint application of G CSF and GM CSF may be better than single liter leukocyte role. January 2001 to December 2004 comparative study of single GM CSF or G CSF combination G CSF and GM CSF treatment Ⅱ degree and above, bone marrow suppression after chemotherapy, 84 cases are as follows:
1 Materials and Methods
1.1 Case selection and grouping
Select by pathology or cytology confirmed as malignant cells WBC <3.0 x 109 / L in patients with 84 cases of peripheral blood granulocytes after chemotherapy, randomized single-blind study, divided into G CSF group (G group: n = 28) , GM CSF group (GM group: n = 28), the combined treatment group (G / GM group: n = 28).
1.2 General Information
84 patients, 48 males and 36 females, including 26 cases of lung cancer, 10 cases of breast cancer, stomach cancer six cases, esophageal cancer 16 cases, 13 cases of malignant lymphoma, nasopharyngeal carcinoma, 10 cases of bone and soft tissue sarcoma patients. Are the initial chemotherapy, age 14 to 70 years, as shown in Table 1. Table 1 general condition of patients
G-GM group G / GM group the number of cases (n) 282828 age 51.3 ± 10.252.7 ± 11.650.7 ± 10.8 Gender (male / female) 16/1215/1317/11 disease (cases) of breast cancer, 334 lung cancer 978 gastric 213 the nasopharyngeal 451 malignant lymphoma, esophageal cancer 545 466 bone and soft tissue sarcoma 121
1.3 mode of administration
The chemotherapy drug cyclophosphamide, mitomycin, epirubicin, vindesine, etoposide, paclitaxel, cisplatin and vinorelbine, oxaliplatin, etc..
G CSF (commodity Ming Teer Tianjin) liters of white blood cell drug selection Xiamen the Turbosound Biological Engineering Co., Ltd. production and GM CSF (commodity Ming Teer legislation). Mode of administration: G group, G CSF 150 μg / d subcutaneous injection; GM group, GM CSF 150μg / d subcutaneous injection; G / GM group G CSF 75μg / d and GM CSF 75 μg / d subcutaneous injection . Stopping criteria: medication during the WBC daily check blood for two days in a row the WBC ≥ 8.0 × 109 / L. In the treatment process does not use drugs affect blood routine.
1.4 Data collection and statistical processing
Collect the following data: (1) CSF WBC returned to normal (WBC ≥ 4.0 × 109 / L) the number of days required; (2) disable CSF 48h after WBC count; (3) disable CSF48h PLT count; (4) The incidence of adverse reactions.
Data ± s, the samples were compared using the t-test.
The use CSF treatment, the three groups of patients can effectively enhance the white blood cells. Significantly longer than the normal number of days on the GM group (8.68 ± 2.47) days of recovery in WBC G group (6.07 ± 1.58) days and G / GM group (6.91 ± 1.94) days, P <0.05; WBC count after 48h withdrawal GM group [( 6.75 ± 1.78) × 109 / L and G / GM group [(7.87 ± 1.38) × 109] was significantly higher than that in group G [(5.03 ± 1.52) × 109 / L, P <0.05, Table 2. Table 2 CSF WBC group close to the incidence of adverse reactions, no significant difference between the two groups. Adverse reactions in patients with mild symptoms, symptomatic treatment can alleviate, as shown in Table 4.
Cancer chemotherapy, the most common dose-limiting toxicity was myelosuppression, mainly in the reduction of the WBC. This not only results in Table 4 CSF infection adverse reactions
Group G GM group G / GM the group bone pain (cases) 576 fever (cases) 344 local reactions (for example) 232 total incidence (%) 37.75043
And reduced immune function, but also affect the chemotherapy schedule and a sufficient dose of chemotherapy use. The application of hematopoietic stem cell colony-stimulating factor (CSF), provides an effective means to solve this problem. Basic research shows that , the role of the G CSF granulocyte set drop-forming units (of CFU G) so that differentiation to mature granulocytes, while the main role of GM CSF granulocyte cell giant macrophage cells set drop-forming units (CFU GM ), to stimulate the granulocyte colony-forming units (CFU G) and macrophage colony-forming units (CFU M) differentiation. Clinical application CSF WBC, ANC reduce chemotherapy-induced decline, and shorten the WBC The ANC decrease the duration, and promote WBC, the ANC recovery, so that chemotherapy schedule. Combined cytokines have a synergistic effect, not only can prevent leukocyte reduction can also reduce platelet decline. This study found that the use of CSF treatment, the three groups of patients can effectively enhance white blood cells, and restore the normal number of days on the GM group (8.68 ± 2.47) in WBC days was significantly longer than the G group (6.07 ± 1.58) days and G / GM group (6.91 ± 1.94 ) days, P <0.05. GM CSF and the combination group G CSF rapid onset, less intensity focused related to their sites of action, greatly enhance leukocyte quickly. GM CSF role in stem cell differentiation to a variety of progenitor cells, the role of points, l leukocyte speed is slow. Withdrawal 48h WBC count the GM group [(6.75 ± 1.78) × 109 / L and G / GM group [(7.87 ± 1.38) × 109 / L] was significantly higher than that of group G [(5.03 ± 1.52) x 109 / L], P <0.05. Description GM CSF and the combination of liters of white blood cell role lasts longer, the highest white blood cell count of the combined treatment group, may be fast-liter leukocyte G CSF, GM CSF also began to play a role to supplement the number of white blood cells and prolonged leukocyte half-life 2]. [3,4] is consistent with other reports at home and abroad. GM CSF can stimulate macrophage colony growth, there is a theoretical promote platelet mature functionality. This article observed after discontinuation 48h, PLT counting GM group (169.2 ± 86.6) × 109 / L and G / GM group (184.7 ± 62.5) × 109 / L] was significantly higher than that in group G [(81.2 ± 51.2) × 109 / L], P <0.05. Group G PLT count after treatment than before treatment decreased macrophage colony growth may be no stimulus G CSF after chemotherapy the platelet continue to reduce related. The group observed G CSF and GM CSF combination therapy can quickly stimulate the recovery of white blood cells, similar to the group G CSF, avoiding the rapid decline of the white blood cells after stopping GM CSF group, and the combination promote platelet recovery schedule chemotherapy combination therapy to better ensure guarantee chemotherapy coherence [4,5].
Reported in the literature CSF application fever, bone pain, local induration complications was observed for the three groups of complications was no difference in the incidence of adverse reactions in patients with mild symptomatic treatment can alleviate, does not affect the treatment.
In summary, the combination of GM-CSF and G CSF safe, effective treatment of bone marrow suppression after chemotherapy, can avoid the drawbacks of the single drug, and the incidence of adverse reactions was no significant difference, bone marrow suppression after chemotherapy treatment.