粒细胞集落刺激因子治疗急性淋巴细胞白血病疗效观察

我们对急性淋巴细胞白血病 (ＡＬＬ)患儿在化疗基础上应用重组人粒细胞集落刺激因子 (ｒｈＧ ＣＳＦ) ,观察化疗后骨髓抑制时对血白细胞 (ＷＢＣ)和中性粒细胞绝对值 (ＡＮＣ)的影响 ,现报告如下。对象与方法一、对象　 1998～ 2 0 0 1年新乡医学院第一、二附属医院住院的ＡＬＬ患儿 5 2例 ,均为初治患儿 ,年龄 1～ 12岁 ,平均6 .2岁 ,均符合血液病诊断及疗效标准[1] 。二、化疗方案及分组　均采用ＶＤＰ(长春新碱、柔红霉素、泼尼松 )或ＣＯＤＰ +Ｌ(环磷酰胺、长春新碱、柔红霉素、泼尼松、天门冬酰胺酶 )方案。其中 30例应用ｒｈＧ ＣＳ…     

粒细胞集落刺激因子在儿童急性髓性白血病治疗中的应用

为了增加强化疗的安全性,15例次初治及32例次巩固强化治疗的急性髓性白血病患儿化疗中应用粒细胞集落刺激因子,中性粒细胞绝对值小于0.5×10~9/L的持续时间分别为5.3天、5.0天,与化疗方案相同的对照组相比分别缩短了5.6天、3.6天;感染发生率为40％、25％,较对照组下降了26.7％,19.4％,具显著差异(P<0.05);输血量亦随之减少,副作用少,提高了病人的生活质量,为强化疗治疗小儿急性髓性白血病提供了保障。     

粒细胞集落刺激因子在小儿急性白血病治疗中的应用

小儿急性白血病在强化疗时白血病细胞被杀灭，正常造血尚未重建，由此导致感染、出血、贫血、在化疗后使用重组人粒细胞集落刺激因子(rhg-csf)减轻强烈化疗的骨髓抑制，缩短和减轻中性粒细胞减少期，使化疗强度加大，达到强化疗目的。现将我院应用rhg-csf的15例临床疗效报道如下。     

急性感染时血清粒细胞集落刺激因子的检测

目的探讨急性感染时血清粒细胞集落刺激因子（Ｇ－ＣＳＦ）水平的变化规律，为急性感染的诊断提供依据。方法肺部感染、消化道感染及全身感染患者共７０例，入院当天均作血清Ｇ－ＣＳＦ血培、养及血常规检测。Ｇ－ＣＳＦ的测定采用双抗体夹心酶联免疫法。对测定结果进行统计学处理。结果７０例急性感染患者，Ｇ－ＣＳＦ阳性者４４例，阳性率为６２．８５％，细菌培养３４例阳性，阳性率为４８．５７％。肺部感染、消化道感染及全身感染，Ｇ－ＣＳＦ的阳性率分别为３０％、６９％、８３％。７０例患者血培养阳性者１８例（２５．７％）。与Ｇ－ＣＳＦ阳性率相比，差异非常显著（Ｐ＜０．００１）。４４例Ｇ－ＣＳＦ阳性患者抗感染治疗前后中性粒细胞绝对值（ＡＮＣ）分别为（８．３８±３．３９）×１０９／Ｌ和（４．１２±１．４７）×１０９／Ｌ（ｔ＝７．６１，Ｐ＜０．００１）。结论急性感染患者血清中Ｇ－ＣＳＦ水平显著升高。测定血清Ｇ－ＣＳＦ可作为判断细菌感染的敏感指标，与血培养及血常规检查相比，其敏感度、阳性率高，但特异性较差。     

白血病患儿重组粒细胞集落刺激因子血药浓度监测及临床意义

目的研究急性白血病患儿反复应用重组粒细胞集落刺激因子(rhG-CsF)的药代动力学及其与临床的关系。方法应用酶联免疫吸附测定(ELIsA)方法检测46例白血病患儿的血清G-CSF浓度。结果获得29例患儿用rgG-CSF后的标本,其血清G-CSF浓度为(5.335±5.597)μg/L。反复应用rhG-CSF的患儿在下次用药前血清G-CSF水平恢复正常;少数未应用rgG-CSF患儿可检测到较高浓度的G-CsF。血清G-CSF浓度与粒细胞绝对计数值呈负相关(r=-0.8746,P＜0.01)。结论rhG-CSF的药代动力学中存在有粒细胞介导的清除机制,反复应用无药物蓄积作用。     

粒细胞巨噬细胞集落刺激因子与感染

粒细胞巨噬细胞集落刺激因子(GMCSF)是造血细胞因子家族中的成员,是一种能在造血干细胞、祖细胞和成熟细胞不同水平上促其生成的多向性造血因子和内源性调节因子。GMCSF作为一种内源性调节因子在抗感染免疫中对某些细菌、真菌、病毒和寄生虫感染中有重要作用。具有潜在的临床应用价值     

新生儿感染血清粒细胞集落刺激因子的测定

观察50例新生儿感染血清粒细胞集落刺激因子（C-CSF）水平变化，发现急性期高于恢复期，外周血中性粒细胞计数与C-CSF呈正相关，重症感染患儿C-CSF明显下降.表明新生儿感染时自身能产生大量G-CSF参与免疫反应，G-CSF水平与疾病程度有关。     

新生儿感染血清粒细胞集落刺激因子的测定

粒细胞集落刺激因子（G－CSF）是一种能刺激中性粒细胞的产生和使其激活的一种糖蛋白[1]。在抗原、内毒素的作用下，G－CSF可由被激活的单核细胞、巨噬细胞、内皮细胞等产生[2]。我们检测了新生儿感染时血清G－CSF水平变化，并探讨其与中性粒细胞、C-反应蛋白（CRP）及黄疸的关     

哮喘儿粒细胞集落刺激因子和肿瘤坏死因子的变化

目的探讨小儿哮喘血粒细胞集落刺激因子(G-CSF)和肿瘤坏死因子α(TNF-α)变化.方法采用ELISA法测定30例健康儿童、52例哮喘急性期和38例治疗后患儿静脉血G-CSF和TNF-α水平.结果急性期G-CSF阳性38/52例,TNF-α水平高于治疗后和对照组,差异显著(P＜0.01).缓解期25/38例G-CSF转阴,TNF-α与对照组比较仍明显升高(P＜0.01).G-CSF与TNF-α含量呈正相关,急性期r=0.614,缓解期r=0.461 P＜0.01.结论哮喘患儿血清G-CSF和TNF-α增高,参与了哮喘病理炎症发展.     

集落刺激因子在小儿急性淋巴细胞白血病中应用的系统评价证据

急性淋巴细胞白血病(ALL)是小儿常见的血液系统恶性肿瘤,为了提高患儿的生存率,常使用高强度的化学疗法及先进的支持疗法[1]。化学治疗时骨髓抑制所致的热性中性粒细胞减少症已成为小儿ALL淋巴细胞白血病治疗过程中的主要问题[2]。中性粒细胞减少症不但严重威胁患儿的生命,还延长患儿的住院时间,增加医疗成本[3]。在接受化学治疗的ALL患儿常使用集落刺激因子(CSF)来防治中性粒细胞减少症的发生。经过试验研究用于临床的CSF有2种:中性粒细胞集落刺激因子(G_CSF)和中性粒细胞巨噬细胞集落刺激因子(GM_CSF)[4]。成人中这2种集落刺激…     

儿童急性白血病及恶性淋巴瘤的靶向治疗

随着对急性白血病、恶性淋巴瘤发病机制的认识逐渐深入，潜在的治疗靶点逐渐浮出水面，大量针对这些靶点的靶向治疗药物及治疗方案已进入临床研究阶段或已应用于临床治疗，其中针对融合基因、酪氨酸激酶受体、白血病细胞表面CD分子、凋亡基因/受体的靶向治疗方案以及法尼基转移酶抑制剂、血管生成抑制因子等靶向治疗药物是近年来研究较活跃的领域，本文就其研究现状及进展作一综述。     

Serum lysozyme level in children with acute leukemia and malignant diseases

Serum lysozyme activity was measured in samples from 65 children with acute lymphatic and myelogenous leukemia, solid tumors and malignant lymphoma in comparison with 45 healthy children. All children with acute lymphatic leukemia (ALL) had significantly reduced levels of lysozyme before starting therapy compared with a control group (p less than 0,01). Children with ALL in complete remission had lysozyme levels comparable to normal children, while children with ALL in relapse showed pathological low levels again. Children with acute myelogenous leukemia (AML), solid tumors and malignant lymphomas had higher lysozyme concentration before therapy than healthy children. Determination of lysozyme activity in children with acute leukemia and malignant tumors is of value for diagnosis and to control the effect of therapy.     

Reversible posterior leukoencephalopathy syndrome in children undergoing induction therapy for acute lymphoblastic leukemia

We present three cases of children with acute neurologic changes while undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL). These cases fall into the spectrum of reversible posterior leukoencephalopathy syndrome (RPLS), including abrupt alterations in mental status, headache, seizures, visual changes, hypertension, and characteristic findings on magnetic resonance imaging. Although the underlying mechanism of RPLS is still under investigation, the appropriate treatment and management of the acute event is becoming clearer. Early treatment of hypertension, control of seizure activity, and withdrawal of inciting agents can lead to rapid reversal of symptoms and return to baseline functioning.     

急性白血病并急性肿瘤溶解综合征8例

目的 观察急性白血病(AL)诱导化疗后急性肿瘤细胞溶解综合征(ATLS)的发生率、临床特点、生化改变及预后。方法 分析化疗后ATLS的发生情况。结果 ATLS发生率为3．72％；年龄3～14岁；急性淋巴细胞白血病(ALL)6例，急性非淋巴细胞白血病(ANLL)2例。临床特征为白细胞及幼稚细胞比例较高，骨髓增生极度活跃、幼稚细胞0．78～0．96，对化疗敏感。诱导化疗开始后12～36h内出现ATLS，表现为高尿酸、高钾、高磷、低钙血症及肾功能损害。6例3～8d后生化指标恢复正常，2例死于急性肾衰竭。结论 ATLS常发生在肿瘤负荷大、对化疗敏感AL患儿。严密观察生化指标、早期诊断及治疗是降低ATLS死亡率关键。     

Plerixafor plus granulocyte-colony stimulating factor for autologous hematopoietic stem cell mobilization in patients with metastatic neuroblastoma

Current therapies for high-risk neuroblastoma (NB) necessitate the availability of several aliquots of autologous peripheral blood stem cells to reverse-associated myelosuppression. Priming with the CXCR4 inhibitor plerixafor plus G-CSF was associated with successful stem cell harvest in 5/7 heavily prior-treated patients with stage 4 NB who had previously failed G-CSF priming. Minimal residual disease was not detected in harvested cells from any patient despite the presence of disease in bone/bone marrow in 6/7. Hematopoietic reconstitution was achieved in all three patients receiving plerixafor-primed stem cells after myeloablative therapy. Plerixafor is an effective and safe agent for stem cell collection in patients with NB.     

Demographic correlates of body size changes in children undergoing treatment for acute lymphoblastic leukemia

INTRODUCTION: While it is known that leukemia therapy is associated with obesity in survivorship, limited information is available on its time-related pattern of development and its variation across patient subgroups. The goal of the present study was to examine demographic correlates of body mass index (BMI) changes over time from diagnosis through chemotherapy for children with B-precursor acute lymphoblastic leukemia (ALL). METHODS: The study cohort consisted of 307 pediatric patients diagnosed with ALL who were treated at four South Texas pediatric oncology centers between 1990 and 2002. To minimize treatment-related variability, we excluded patients who received cranial irradiation as part of their treatment. Variation in age- and gender-standardized BMI z-scores according to age at diagnosis, gender, and ethnicity were assessed. RESULTS: The overall study cohort exhibited an increase in age- and gender-adjusted BMI z-scores for the first 24 months of chemotherapy followed by a slight decrease in BMI at 30 months (end of therapy). A repeated measures analysis indicated a statistically significant difference in the time-related pattern of BMI changes for age at diagnosis (P = 0.001) but no significant effect for gender (P = 0.32) or Hispanic versus non-Hispanic ethnicity (P = 0.89). DISCUSSION: In our cohort of ALL patients, BMI was elevated at diagnosis (mean standardized BMI z-score = 0.22, standard deviation = 1.4) then increased and remained elevated for the entire duration of chemotherapy. Children who were 2-9 years of age at diagnosis began therapy with a substantially lower BMI and remained lower over the course of chemotherapy than patients aged 10-18 years at diagnosis. It will be important for future investigations to explore the biological and behavioral factors that may underlie such differential patterns of BMI change over time.     

粒细胞集落刺激因子对移植的人神经干细胞体内分化的影响

目的 观察缺氧缺血性脑损伤(HIBD)新生大鼠应用粒细胞集落刺激因子(G-CSF)对移植的人神经干细胞(hNSCs)体内分化成星形胶质细胞的影响.方法 新生1周的Wistar大鼠建立HIBD模型后分成2组:NSC移植组(A组,n ＝ 16)和NSC移植 + G-CSF治疗组(B组,n ＝ 16),其中B组建模后1 h即开始皮下注射G-CSF,1次/d,移植前后连续5 d注射G-CSF.两组均于建模后第2天经脑室移植hNSCs.移植后1、2周分别用免疫荧光法检测植入细胞在大鼠脑内向星形胶质细胞分化的情况.结果 移植后1周,B组植入细胞分化的星形胶质细胞数量较A组多,差异有统计学意义(t ＝ 4.83,P ＜ 0.01).移植后2周,两组植入细胞分化的星形胶质细胞数量上差异无统计学意义(t ＝ 1.59,P ＞ 0.05).结论 G-CSF能在移植后早期促进植入的外源性NSCs向星形胶质细胞分化.     

The in vivo effect of recombinant human granulocyte-colony stimulating factor in neutropenic neonates with sepsis

The effects of recombinant granulocyte-colony stimulating factor (rhG-CSF) in neonatal neutropenia with presumed sepsis, which has a poor prognosis, were investigated. The study involved 14 neonates with presumed sepsis and neutropenia. Findings were compared with those from 24 historical controls. rhG-CSF (5 μg/kg/day i.v. for 5 days) was administered immediately following diagnosis. Complete blood counts were obtained before and 24, 48, 72, 96 and 120 h after initiation of treatment. Neutrophil storage pool (NSP) was assessed (in 4 patients) before and after treatment. Statistical analysis was performed using one way analysis of variance. Treatment led to an increase in absolute neutrophil count (ANC) levels in 13/14 patients. At the end of treatment, the mean ANC was higher than that of controls (P = 0.007). There was a marked increase in the NSP of between 32% and 65% (P = 0.005). There were two clinical failures, one of whom was considered to have died from his underlying condition. There were no reports of clinical or haematological toxicity during treatment or follow up. Received: 14 June 1996 / Received in revised form and accepted: 15 November 1996