소아 급성 백혈병에서 항암화학요법 후 호중구 감소시 세포충실도에 따른 rhG-CSF및 rhGM-CSF의 효과

Abstract

Background: An increased dosage of chemotherapy and a trial of bone marrow transplantation in acute leukemia result in severe marrow suppression. As the risk of infection associated with chemotherapy is related to the depth of the fall in neutrophil counts, recombinant human granulocyte colony-stimulating factor(rhG-CSF) and recombinant human granulocyte macrophage colonystimulating factor(rhGM-CSF) have been used clinically to accelerate the recovery of normal myelopoiesis after intensive chemotherapy or bone marrow transplantation. Methods: We conducted a randomized, controlled study to evaluate the efficacy and safety of rhG-CSF and rhGM-CSF after intensive chemotherapy in 54 children with acute leukemia(29 cases of CSF treated group, 25 cases of control group) . Patients assigned to the rhG-CSF or rhGM-CSF group received 5 ㎍/kg, daily, starting several days after the last day of induction chemotherapy and until the peripheral absolute neutrophil count surpassed 1000/mm3. Results: 1) The time needed to reach neutrophil recovery of >500/mm3, > 1000/mm3, and of > 1500/mm3 was significantly shorten in rhG-CSF or rhGM-CSF group than control group. 2) The median administration duration of rhG-CSF or rhGM-CSF was 9.0±6.3 days 3) The hospitalization duration was shorter in rhG-CSF or rhGM-CSF group than control. 4) Bone marrow cellularity was increased from 18.5±15.1% to 38.8±28.4% after rhG-CSF or rhGM-CSF administration, but no difference was observed in control group. 5) Side effect of rhG-CSF or rhGM-CSF were observed fever(10.3%), nausea(3.4%) chest discomfort(3.4%), paresthesia(3.4%), but these reactions were transient and recovered without specific treatment. Conclusion: These results suggests that rhG-CSF or rhGM-CSF induces accelerated recovery after intensive chemotherapy in children with acute leukemia. The increase in bone marrow cellularity after rhG-CSF or rhGM-CSF administration seems to have correlation with effect of rhG-CSF or rhGM-CSF. Further long term observations are needed to evaluate the effect on leukemia relapse or rhG-CSF or rhGM-CSF.