소아 급성 비림프구성 백혈병에서 Idarrubicin과 Cytosine arabinoside로 관해유도후에 과립구-집락자극인자의 효과

Abstract

Currently, treatment of acute nonlymphocytic leukemia(ANL ) is very intensive for all patients. It is necessary to produce maked marrow hypoplasia in most patients in order to induce a remission Granulocyte colony-stimulating factor(G-CSF) induces the proliferation and differentiation of normal marrow granulocytic precursors, and it has been used clinically to accelerated the recovery of normal myelopoiesis after intensive chemotherapy or bone marrw transplantation. We conducted a prospective, randomized, controlled study to evaluate the remission rate, efficacy and safety of recombinant human G-CSF(rhG-CSF) after intensive induction chemotherapy with idarubicin(12 mg/m2/day, day 1-day 3) and cytosine arabinoside(100 mg/m2 /day, day 1-day 7) in 44 children with ANL(30 cases of rhG-CSF group, 14 cases of control group). Administration of rhG-CSF(5 ㎍/kg/day) was begun on day 8 and continued for 14 days. The results were as follows. 1) Complete remission rate after induction chemotherapy in both rhG-CSF group and control group was 50% (15/30) and 42.175 (6/14), respectively. 2) Total leukocyte and neutrophil count were significantly increased on day 22 in FhG-CSF group, compared with the control group respectively. 3) Recovry of platelet count was no statistical difference between rhG-CSF and control group. 4) Incidence of febrile episodes, duration of ferile days and administraion days of antibiotics were no statistical difference between rhG-CSF and control group respectively. 5) side effects of rhG-CSF were observed elevation of SGOT, SGPT or alkaline phosphatase(26.7%), skin rash(13.3 % ) and headache(3.3 % ), but these reactions were transient and recovered without specific treatment. There was no evidence that rhG-CSF accelerated the proliferation of leukemic cells. These results suggest that rhG-CSF induces neutrophil recovery after intensive induction chemotherapy in children with ANL without significant toxicity. However, further long-term observations are needed to assess the effects on infection and leukemia relapse of rhG-CSF.