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- W2000104575 abstract "We appreciate the opportunity to respond to the letter to the editor “Myeloprotection Following Cytotoxic Damage: The Sooner the Better,” by Francis Hérodin and Michel Drouet, which addressed our article entitled “Efficacy of Delayed Administration of Postchemotherapy Granulocyte Colony-Stimulating Factor: Evidence from Murine Studies of Bone Marrow Cell Kinetics” [1Yankelevich M. Goodell M.A. Kaplan J. Efficacy of delayed administration of postchemotherapy granulocyte colony-stimulating factor: evidence from murine studies of bone marrow cell kinetics.Exp Hematol. 2008; 36: 9-16Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar]. We appreciate the authors’ comments on our article, but the issues raised are distinct from the central focus of our article. Drs. Herodin and Drouet discuss the effects of cytokines on survival of irradiated mice first demonstrated by Tanikawa et al. [2Tanikawa S. Nose M. Aoki Y. Tsuneoka K. Shikita M. Nara N. Effects of recombinant human granulocyte colony-stimulating factor on the hematologic recovery and survival of irradiated mice.Blood. 1990; 76: 445-449PubMed Google Scholar]. We agree with their comments as they relate to survival of animals and blood count recovery following administration of various growth factors and cytokines after myeloablative treatment. However, they are not germane to the results reported in our article. Thus, in contrast to the results alluded to in the letter by Drs. Herodin and Drouet, our results describe changes in blood cell populations following use of a single specific growth factor, i.e., nonpegylated granulocyte colony-stimulating factor (G-CSF), to ameliorate the neutropenic periods seen after nonmyeloablative chemotherapy—a situation more commonly encountered in clinical practice. “Short-acting” cycle-active cytotoxic agents like cyclophosphamide administered in conventional doses affect actively dividing bone marrow precursor cells and do not affect stem cells. Consequently, the myelosuppression is typically short-lasting [3Kim S.K. Demetri G.D. Chemotherapy and neutropenia.Hematol Oncol Clin North Am. 1996; 10: 377-395Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar]. This is fundamentally different from radiation-induced myelosuppression (especially total body irradiation), where the damage is deeper to the level of stem cells and the period of bone marrow recovery is much longer. Clearly, G-CSF−associated shortening of postchemotherapy neutropenia is a result of increased amplification of immature granuloid cells (due to increased cycling and reduced transit time [3Kim S.K. Demetri G.D. Chemotherapy and neutropenia.Hematol Oncol Clin North Am. 1996; 10: 377-395Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar]), while the cytokine-associated rescue from the lethal doses of irradiation could be a result of prevention of apoptosis and shortening the period of GO residence of the stem cells [2Tanikawa S. Nose M. Aoki Y. Tsuneoka K. Shikita M. Nara N. Effects of recombinant human granulocyte colony-stimulating factor on the hematologic recovery and survival of irradiated mice.Blood. 1990; 76: 445-449PubMed Google Scholar]. The cytokines mentioned in their letter (stem cell factor, interleukin-3, Flt3 ligand, thrombopoietin, pegylated G-CSF) have different properties from G-CSF, are not used in clinic, or have limited application. G-CSF−related thrombocytopenia is a well-known phenomenon. Drop in platelet counts in healthy donors are seen by day 8 [4Stroncek D.F. Clay M.E. Petzoldt M.L. et al.Treatment of normal individuals with granulocyte colony-stimulating factor: donor experiences and the effects on peripheral blood CD34+ cell counts and on the collection of peripheral blood stem cells.Transfusion. 1996; 36: 601-610Crossref PubMed Scopus (222) Google Scholar, 5Tassi C. Tazzari P.L. Bonifazi F. et al.Short- and long-term hematological surveillance of healthy donors of allogeneic peripheral hematopoietic progenitors mobilized with G-CSF: a single institution prospective study.Bone Marrow Transplant. 2005; 36: 289-294Crossref PubMed Scopus (40) Google Scholar]. The mechanism of G-CSF−related thrombocytopenia is not exactly clear. G-CSF may directly act on bone marrow megakaryocytes and decrease platelet production, directly act on platelets (platelets have been shown to have G-CSF receptors), or produce thrombocytopenia through development of hypersplenism. The latter may be more pronounced in mice vs humans or other primates. In fact, depending on the stimulation schedule, the spleen weights after G-SCF stimulation in our experiments were two to three times higher than the chemotherapy-only regimen (unpublished data). Our model, like many animal models, has some limitations, but the statement that “one can wonder whether such a model is appropriate to evaluate the kinetic effects of G-CSF administration in a context of myelosuppressive chemotherapy” is not based on any specific issues raised in their letter. The speed of hematopoiesis in mice is indeed about twice as fast as humans, due to the differences in interphase duration, consequently, the neutropenic nadirs in mice develop sooner and the neutrophil recovery time is shorter; however, one still has 7 to 10 days to follow kinetics of recovery in mice compared to 14 to 20 days in humans. Finally, we studied the colony-forming units in culture in spleens because the stem and progenitor cells seed this organ after mobilization in mice, however, we agree with Drs. Herodin and Drouet that the murine colony-forming unit mobilization data are difficult to translate to humans. Myeloprotection following cytotoxic damage: The sooner the betterExperimental HematologyVol. 36Issue 7PreviewThe article by Yankelevich, Goodell, and Kaplan, “Efficacy of Delayed Administration of Postchemotherapy Granulocyte Colony-Stimulating Factor: Evidence from Murine Studies of Bone Marrow Cell Kinetics” [1] is an original study designed to help clinicians improve safe and efficient use of granulocyte colony-stimulating factor (G-CSF) postchemotherapy in humans. Although the authors did not generalize their results to the use of cytokines in other contexts of bone marrow aplasia, their conclusions might confuse the readers and let them think that delaying G-CSF (or cytokines in general) could be beneficial in any situation of hematopoietic distress. Full-Text PDF Open Access" @default.
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- W2000104575 title "Reply to Hérodin and Drouet: “Myeloprotection Following Cytotoxic Damage: The Sooner the Better”" @default.
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