High-dose chemotherapy often requires hematopoietic progenitor cell reinfusion, but drugs with extramedullary dose-limiting toxicity may be administered in the high-dose range by simple growth factor support. In this study, we evaluated the feasibility and toxicity of a three-drug high-dose regimen supported by recombinant human granulocyte colony-stimulating factor (rhG-CSF). Ten patients with histologically proven malignancy were enrolled. Eight had breast cancer, one non-Hodgkin's lymphoma, and one a mediastinal tumor of unknown origin. The regimen included cyclophosphamide (C) 5 g/m2, etoposide (E) 1.5 g/m2, and cisplatin (P) 150 mg/m2 (CEP), administered in a 3-day schedule followed by rhG-CSF, 300 micrograms once a day, beginning from day +5 (36 h after the end of chemotherapy). The cycle was repeated as clinically needed up to three times. After the first course, hematologic recovery was rapid and complete without documented infections, and no relevant extramyeloid toxicities were observed. Eight of 10 patients received a second course with comparably low toxicity, and three of them received a third course. We concluded that CEP therapy can be administered safely and even repeatedly, by simple growth factor support, in good performance status cancer patients.

译文

大剂量化疗通常需要造血祖细胞回输,但具有髓外剂量限制毒性的药物可以通过简单的生长因子支持在高剂量范围内施用。在这项研究中,我们评估了由重组人粒细胞集落刺激因子 (rhG-CSF) 支持的三药大剂量方案的可行性和毒性。纳入了10例经组织学证实为恶性肿瘤的患者。8人患有乳腺癌,1人患有非霍奇金淋巴瘤,1人患有不明原因的纵隔肿瘤。该方案包括环磷酰胺 (C) 5g/m2,依托泊苷 (E) 1.5g/m2和顺铂 (P) 150 mg/m2 (CEP),以3天的时间表施用,然后是rhG-CSF,300微克每天一次,从第5天开始 (化疗结束后36小时)。根据临床需要重复循环多达三次。第一个疗程后,血液学恢复迅速而完整,没有记录的感染,也没有观察到相关的髓外毒性。10名患者中有8名接受了毒性相对较低的第二疗程,其中3名接受了第三疗程。我们得出的结论是,在表现良好的癌症患者中,通过简单的生长因子支持,可以安全甚至反复地进行CEP治疗。

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