内容紹介
Appropriate Use of Granulocyte Colony-Stimulating Factor in the Management of Hematologic Malignancies
Summary
There are two main types of therapy for hematologic malignancies: intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation(HSCT). The roles of granulocyte colony-stimulating factor(G-CSF)in patients receiving HSCT are the mobilization of hematopoietic stem cells/progenitor cells i
nto peripheral blood and the enhancement of neutrophil recovery as therapy or prophylaxis for fatal complications following HSCT. In the treatment of acute leukemias, G-CSF is used as therapy or prophylaxis for febrile complications during remission induction and post-remission therapies. In the treatment of lymphomas, primary prophylactic G-CSF is recommended during all cycles of chemotherapy when the expected incidence of neutropenic fever is more than 20% or when the patient is treated with potentially curative regimens. G-CSF is used as secondary prophylaxis to maintain dose intensity in patients with lymphomas treated in settings where reductions in chemotherapy dose intensity or dose density are associated with poorer prognosis. In the treatment of multiple myelomas, prophylactic G-CSF can be used when there is a high estimated risk of neutropenic fever(e. g., in patients receiving high-dose chemotherapy). For all cases, the appropriate use of G-CSF is recommended in accordance with the guidelines of the American Society of Clinical Oncology(ASCO), European Organisation for Research and Treatment of Cancer(EORTC), Infectious Diseases Society of America(IDSA), National Comprehensive Cancer Network(NCCN), and our JSCO-2013.
要旨
造血器腫瘍の治療は強力な化学療法と,適応に応じて造血幹細胞移植療法が選択される。造血幹細胞移植療法におけるG-CSFは,造血幹細胞/造血前駆細胞の末梢血液への動員と,移植後の重篤な好中球減少に伴う致死的合併症への治療的あるいは予防的投与で使用される。急性白血病におけるG-CSFは,寛解導入療法・寛解後療法後の重篤な好中球減少に伴う発熱性合併症への治療的あるいは予防的投与で使用される。リンパ腫におけるG-CSFは治癒をめざして,発熱性好中球減少症(FN)の発症が20%を超えるような強力な化学療法では一次予防的投与での使用が推奨される。FNの発症が20%以下の治療では前コースの治療でFNの発症があり,治療強度の減弱につながる場合は二次予防的投与で使用される。多発性骨髄腫では,大量化学療法時やFN発症のリスクが高いと予想される場合にG-CSFの予防的投与が使用される。いずれの場合も海外のASCO,EORTC,IDSA,NCCNや,わが国のJSCO-2013のガイドラインを参考にしたG-CSFの適正使用が勧められる。
目次
Summary
There are two main types of therapy for hematologic malignancies: intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation(HSCT). The roles of granulocyte colony-stimulating factor(G-CSF)in patients receiving HSCT are the mobilization of hematopoietic stem cells/progenitor cells i
nto peripheral blood and the enhancement of neutrophil recovery as therapy or prophylaxis for fatal complications following HSCT. In the treatment of acute leukemias, G-CSF is used as therapy or prophylaxis for febrile complications during remission induction and post-remission therapies. In the treatment of lymphomas, primary prophylactic G-CSF is recommended during all cycles of chemotherapy when the expected incidence of neutropenic fever is more than 20% or when the patient is treated with potentially curative regimens. G-CSF is used as secondary prophylaxis to maintain dose intensity in patients with lymphomas treated in settings where reductions in chemotherapy dose intensity or dose density are associated with poorer prognosis. In the treatment of multiple myelomas, prophylactic G-CSF can be used when there is a high estimated risk of neutropenic fever(e. g., in patients receiving high-dose chemotherapy). For all cases, the appropriate use of G-CSF is recommended in accordance with the guidelines of the American Society of Clinical Oncology(ASCO), European Organisation for Research and Treatment of Cancer(EORTC), Infectious Diseases Society of America(IDSA), National Comprehensive Cancer Network(NCCN), and our JSCO-2013.
要旨
造血器腫瘍の治療は強力な化学療法と,適応に応じて造血幹細胞移植療法が選択される。造血幹細胞移植療法におけるG-CSFは,造血幹細胞/造血前駆細胞の末梢血液への動員と,移植後の重篤な好中球減少に伴う致死的合併症への治療的あるいは予防的投与で使用される。急性白血病におけるG-CSFは,寛解導入療法・寛解後療法後の重篤な好中球減少に伴う発熱性合併症への治療的あるいは予防的投与で使用される。リンパ腫におけるG-CSFは治癒をめざして,発熱性好中球減少症(FN)の発症が20%を超えるような強力な化学療法では一次予防的投与での使用が推奨される。FNの発症が20%以下の治療では前コースの治療でFNの発症があり,治療強度の減弱につながる場合は二次予防的投与で使用される。多発性骨髄腫では,大量化学療法時やFN発症のリスクが高いと予想される場合にG-CSFの予防的投与が使用される。いずれの場合も海外のASCO,EORTC,IDSA,NCCNや,わが国のJSCO-2013のガイドラインを参考にしたG-CSFの適正使用が勧められる。