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성인 급성 골수성백혈병에서 과립구 및 과립구-대식세포 집락촉진인자가 감염증에 미치는 영향

Other Titles
 Effect of Granulocyte or Granulocyte/MacroPhage Colony-Stimulating Factors on Infection in Adult Acute Myeloid Leukemia 
 김성철  ;  민유홍  ;  이석  ;  정소영  ;  유내춘  ;  한지숙  ;  고윤웅 
 Korean Journal of Hematology (대한혈액학회지), Vol.31(2) : 275-288, 1996-07 
Journal Title
Korean Journal of Hematology(대한혈액학회지)
Issue Date
Acute myeloid leukemia ; Recombinant human granulocyte or granulo-cyte/macrophage colony-stimul
Background: Through recent progress in chemotherapy and bone marrow transplantation, patients with acute myeloid leukemia(AML) have shown a long-term, disease free survival. Myelosuppression from therapy and infections have been the major obstacles in the treatment of acute leukemia. Recently, in order to shorten the duration of neutropenia and reduce the rate of infection, rhG/GM-CSF(recombinant human granulocyte or granulocyte/macrophage colony-stimulating factor) has been used in clinical trials. It has been apparent from earlier studies that rhG/GM-CSF accelerate the recovery of neutrophils after chemotherapy, but there were variable results in the rate of infection, febrile duration, and clinical responses to treatment for infection. Thus we evaluated the effect of rhG/GM-CSF on infection in patients with acute myeloid leukemia.
Methods: This study reviewed the 262 chemotherapy courses of 121 cases with AML from January 1990 to June 1995. G-CSF 5㎍/kg and GM-CSF 250㎍/㎡ was subcutaneously administrated until neutrophil count > 1,000/μL for three consecutive days. When febrile episodes were noted, stepwise-empiric antimicrobial therapy was started with microbial culture study. We compared recovery of neutrophils, infection rate, and clinical response to the treatment of infection in study patients with the results obtained in historical controls.
Results :
1) Of 262 chemotherapy courses, rhG/GM-CSF was administrated in 85 chemotherap courses, and 177 courses were not. In the rhG/GM-CSF group, rInG-CSF was administrated in 37 chemotherapy courses, rhGM-CSF in 48 courses. And rhG/GM-CSF was administrated for prophylaxis of infection in 49 courses. In the remaining 36 courses, it was used for enhancing the effect of treatment on documented infection.
2) Recovery of neutrophils over 500/μL, 1,000/μL and 1,500/μL, respectively, was significantly shorter in the rhG/GM-CSF group than in the control group(P value<0.01).
3) The incidence of documented infection was significantly lower in the rhG/ GM-CSF than in the control group(P value=0.03), and the recovery from neutropenia induced by administration of rhG/GM-CSF is the most important predictor in rate of infection (P value=0.03). The second important factor is the type of chemotherapy(P value=0.05).
4) The duration of febrile days and type of infection were not different between the two groups. Also, the organisms of microbiologically documented infection were not different.
5) In 55 courses with documented infection, rhG/GM-CSF was administrated in combination with antimicrobials. The clinical response to treatment of documented infection in this group was 83.6% , not significantly different from those in the control group(82.4%).
6) There was no statistical difference in the incidence of infection and clinical response according to induction timing of hypoplasia after chemotherapy.
Conclusion: With the above results, we have concluded that rhG/GM-CSF administration after chemotherapy in AML lowers the incidence of infection by accelerating the recovery of neutrophil counts. There is a need to search for earlier administration of rhG/GM-CSF to improve clinical response to treatment of documented infection.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
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