粒细胞集落刺激因子的应用对急性白血病患者预后的影响

目的观察粒细胞集落刺激因子(GCSF)的应用对急性白血病(AL)患者预后的可能影响。方法回顾性研究171例可评价AL患者。分别采用χ2、Cox回归、KaplanMeier等方法分析1疗程完全缓解(CR)率、总CR率、治疗有效率、化疗后WBC减少时间、CR期、生存期及其影响因素;采用等级相关分析GCSF用量与CR期及生存期的关系。急性髓系白血病(AML)患者交替采用以柔红霉素 阿糖胞苷(DA)或高三尖杉酯碱 阿糖胞苷(HA)或米托蒽醌 阿糖胞苷(MA)为主的方案进行诱导缓解和缓解后治疗。急性淋巴细胞白血病(ALL)患者交替采用以长春新碱 柔红霉素 泼尼松(VDP)或长春新碱 阿霉素 泼尼松(VAP)或长春新碱 米托蒽醌 泼尼松(VMP)或环磷酰胺 长春新碱 柔红霉素 泼尼松(CODP)为主的方案进行诱导缓解和缓解后治疗。用药组均在患者WBC<1.0×109/L时予以重组人GCSF(rhGCSF)(1.5～6.0μg·kg-1·d-1),一般WBC达2.5×109/L时停用。结果(1)AL患者化疗后应用GCSF可使化疗后WBC减少时间明显缩短;但不影响患者的1疗程CR率、CR率和治疗有效率;(2)使用GCSF不影响ALL患者CR期,但明显缩短AML患者CR期;(3)使用GCSF不影响ALL患者的生存期,但缩短AML患者的生存期;(4)尚未发现使用GCSF的AML患者中因子用量多少与CR期及生存期存在相关关系。结论AML患者必须非常慎用GCSF。

The potential prognostic influence of granulocyte-colony stimulating factor in acute leukemia

OBJECTIVE: To investigate the potential influence of granulocyte-colony stimulating factor (G-CSF) on the prognosis of patients with acute leukemia(AL). METHODS: In 171 evaluable cases with AL, the complete remission (CR) rate post first course of chemotherapy, CR rate, effective rate, duration of leucopenia post chemotherapy, CR duration, lifespan and the relationship between the dosage of G-CSF and CR duration or lifespan were retrospectively analyzed with Chi-square test, paired t-test, Cox regression, Kaplan-Meier and rank correlation method. For remission induction and postremission therapy, the cases with acute myeloid leukemia (AML) received chemotherapy regimes based on daunorubicin + ara-C (DA), homoharringtonine + ara-C (HA) or mitoxantrone + ara-C (MA). The patients with acute lymphocyte leukemia (ALL) were treated with regimes based on vinblastine + daunorubicin + prednisone (VDP), vinblastine + adriamycin + prednisone (VAP), vinblastine + mitoxantrone + prednisone (VMP) or cyclophosphamide + vinblastine + daunorubicin + prednisone(CODP). In G-CSF group, the patients whose WBC count fell below 1.0 x 10(9)/L after chemotherapy were given rhG-CSF (1.5-6.0 microg.kg(-1).d(-1)) until WBC count restored to 2.5 x 10(9)/L. RESULTS: (1) Patients administered applied with G-CSF had shorter duration of leucopenia. However, there was no statistical difference between the two groups in the CR rate post first course of chemotherapy, CR rate and the effective rate of treatment. (2) Use of G-CSF did not affect CR durations of ALL patients, but shortened that of AML patients. (3) The application of G-CSF had little effect on the lifespan of ALL patients. By contrast, it showed clearly negative effects on that of AML patients. (4) No relationship between the dosage of G-CSF and CR duration or lifespan in AML patients. CONCLUSION: With AML patients, the administration of G-CSF must be very cautious.