28.02.2013 Views

autologous blood and marrow transplantation - Blog Science ...

autologous blood and marrow transplantation - Blog Science ...

autologous blood and marrow transplantation - Blog Science ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

418 Chapter 7: Solid Tumors<br />

CO<br />

><br />

CO<br />

a?<br />

Event-Free Survival after PBSCT : Stage N<br />

— Prospective Study —<br />

100<br />

50<br />

12 16<br />

Months after PBSCT<br />

n=33 23%<br />

24 30<br />

Figure 1. The Kaplan-Meier estimates of event-free survival for children >1 year old with<br />

stage IV neuroblastoma who underwent PBSCT.<br />

G-CSF TREATMENT AFTER AUTOLOGOUS PBSCT:<br />

A PROSPECTIVE RANDOMIZED TRIAL<br />

There is a possibility that additional use of granulocyte colony-stimulating<br />

factor (G-CSF) may further enhance the already fast recovery rate of hematopoiesis<br />

after PBSCT. However, in our study we found that growth factor activities, such as<br />

G-CSF <strong>and</strong> thrombopoietin, can be identified in the serum of transplant<br />

recipients. 2,3<br />

Thus, it is very probable that these endogenously secreted CSFs<br />

provide sufficient stimulation for hematopoietic engraftment without the need for<br />

exogenous cytokines, as previously observed. 4<br />

To clarify this issue, we performed a clinical trial, in which a total of 74 children<br />

scheduled to undergo PBSCT were prospectively r<strong>and</strong>omized at diagnosis to<br />

evaluate the effectiveness of exogenous G-CSF treatment in accelerating<br />

hematopoietic recovery after PBSCT. 5<br />

A total of 63 patients finally underwent<br />

PBSCT; 32 patients in the treatment group (300 pg/m 2<br />

of G-CSF intravenously<br />

over 1 hour from day 1 of PBSCT) <strong>and</strong> 31 in the control group without treatment.<br />

There was no significant difference in the numbers of transfused MNC, CD34 +<br />

cells, or colony-forming units granulocyte/macrophage (CFU-GM) between the<br />

treatment <strong>and</strong> control groups. After PBSCT, the time to achieve an ANC of<br />

>0.5X10 9<br />

/L in the treatment group was 1 day less than that in the control group<br />

(median; 11 vs. 12 days, f

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!