VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

THE USE OF GRANULOCYTE COLONY-STIMULATING FACTOR (G-
CSF)FOLLOWING AUTOLOGOUS BMT IN LYMPHOMAS.
A. Porcellini, A.M. Carella*, A. Manna, C. Bergonzi.
Hematology/BMT Center P.O.C. Cremona and, Hematology/BMT Center S.
Martino Hospital Genova Italy.
Since hemopoietic growth factors have become available in clinical practice,
a number of trials of both G-CSF and GM-CSF, Phase I, II and III, have taken
place in many centers and have involved patients with various neoplastic diseases
treated with chemotherapeutic regimens or myeloablative therapies followed
by BMT. The purpose of combining hemopoietic growth factors with chemotherapy
is to accelerate hematopoietic recovery and to decrease adverse effects
associated with aggressive protocols. This approach may also enable clinicians
to avoid dose reduction or delay in therapy, and potentially to escalate
dose. G-CSF, a lineage specific hemopoietic growth factor, and GM-CSF, an
agent that affects a broader range of cell lineages, have both been studied in
neutropenic patients following cancer chemotherapy and autologous bone marrow
transplantation. A question has been raised as to whether the use of a lineage
restricted growth factor such as G-CSF immediately following ABMT is of
any advantage. In fact if the target of this factor were solely the late maturational
stages of myeloid precursors, then an acceleration of neutrophil recovery would
hardly be explained, following myeloablative chemotherapy and G-CSF administration.
However a body of literature exists (1
' 2A)
indicating that the target of G-
CSF may include multipotential hemopoietic stem cells. Thus, the expansion of
the myeloid compartment seems to be matched by an expanded earlier
pluripotential compartment, probably with an increased fraction of the stem cell
pool entering the proliferative pool. This recruitment and expansion of the more
primitive precursors may be accomplished by acting in synergy with other
cytokines, specifically interleukine-1 (IL-1), IL-6 or the c-kit ligand/stem cell factor
to stimulate proliferation of primitive precursors with functional or phenotypic
features of stem cells 0.5 x 10 9
/L in 17 days, compared with 25 days in historical controls
and was well tolerated.
A multicenter, randomized, placebo-controlled trial was conducted in patients
with lymphoid malignancies (65 in the GM-CSF arm and 63 in the placebo
arm)