neipogeni (NEUPOGEN)
FILGRASTIM
F. HOFFMANN-LA ROCHE, Sveicaria
aTq klasifikaciis kodi
L03AA02
Semadgenloba da gamoSvebis forma
saineqcio xsnari: flakonSi 1 ml. SefuTvaSi 5 c.
1 ml.
filgrastimi . . . . . . . . . 30 mln se (300 mkg)
saineqcio xsnari: Spric-tubSi 1 ml, SefuTvaSi 1 c.
1 ml.
filgrastimi . . . . . . . . . 30 mln se (300 mkg)
Semavseblebi:
natriumis acetatis buferi (pH 4.0), sorbitoli, polisorbati 80, saineqcio wyali.
kliniko-farmakologiuri jgufi
granulocituli koloniamastimulirebeli faqtori
farmakologiuri Tvisebebi
filgrastimi warmoadgens kargad gawmendil araglikozirebul cilas, romelic Sedgeba 175
aminomJavasagan. misi gamomuSaveba xdeba Escherichia coli-s laboratoriuli Stamis mier, romelSic
genuri inJineriis meTodiT Seyvanilia adamianis granulocituli kolonieamastimulirebeli faqtoris
geni.
adamianis granulocituli koloniamastimulirebeli faqtori (a-gkmf) warmoadgens glikoproteins,
romelic aregulirebs funqciurad aqtiuri neitrofilebis warmoqmnas da maT gamosvlas sisxlSi
Zvlis tvinidan. neipogeni, romelic Seicavs rekombinantur a-gkmf-s, sagrZnoblad zrdis
neitrofilebis raodenobas periferiul sisxlSi pirveli 24 saaTis ganmavlobaSi misi Seyvanis
Semdeg, monocitebis raodenobis mcire gazrdiT. zogierT avadmyofebSi mZime qronikuli neitropeniiT,
preparatma SeiZleba gamoiwvios cirkulaciaSi myofi eozinofilebis umniSvnelo momateba sawyis
donesTan SedarebiT. avadmyofTa garkveul nawilSi eozinofilia da bazofilia aRiniSneba preparatis
daniSvnamde.
neitrofilebis raodenobis momateba rekomendebuli dozebis intervalSi damokidebulia preparatis
dozaze. neitrofilebis funqcia, adamianis organizmSi neipogenis Seyvanisas, normaluri an
gaZlierebulia, rac damtkicebulia qemotaqsisis da fagocitozis kvleviT. preparatiT mkurnalobis
damTavrebis Semdeg neitrofilebis ricxvi periferiul sisxlSi mcirdeba 50%-iT 1-2 dRis
ganmavlobaSi da aRwevs normalur dones 1-7 dRis ganmavlobaSi.
neipogeni sagrZnoblad amcirebs neitropeniis da febriluri neitropeniis sixSires, simZimes da
xangrZlivobas, rac xSirad aRiniSneba avadmyofebSi, romlebic itareben qimioTerapiis kurss
citostaturi saSualebebiT, an mieloablatiur Terapias Zvlis tvinis Semdgomi gadanergviT.
avadmyofebi, romlebic itareben mkurnalobas neipogeniT da citostaturi saSualebebiT, an
mieloablatiur Terapias Zvlis tvinis Semdgomi gadanergviT iSviaTad saWiroeben hospitalizacias da
xangrZliv mkurnalobas stacionarSi. amasTan erTad pacientebi, romlebic itareben mxolod
citostatur Terapias saWiroeben antibiotikebis SedarebiT mcire dozebs. neipogeniT mkurnaloba
sagrZnoblad amcirebs febrilur neitropenias, moTxovnilebas antibiotikoTerapiisadmi da
hospitalizaciis saWiroebas induqciuri qimioTerapiis Semdeg mwvave mieloleikozis dros.
cxelebis da dokumentirebuli infeqciebis sixSire am dros ar mcirdeba.
neipogenis gamoyeneba, rogorc damoukideblad, aseve qimioTerapiis Semdeg iwvevs periferiuli sisxlis
hemopoezis winamorbedi ujredebis aqtivirebas. es autologiuri ujredebi-winamorbedebi SeiZleba
Segrovdes da SemdgomSi Seyvanili iqnas citostaturi saSualebebis
didi dozebiT mkurnalobis
Semdeg, Zvlis tvinis gadanergvis nacvlad, an masTan erTad damatebiT. maTi Seyvana aCqarebs
sisxlwarmoqmnis
aRdgenas,
amcirebs
hemoragiuli garTulebebis
warmoqmnis
safrTxes
da
Trombocituli masis gadasxmis saWiroebas rogorc kanqveS, aseve intravenuri Seyvanisas
filgrastimis eliminacia organizmidan mimdinareobs I rigis kinetikis mixedviT. misi naxevargamoyofis
periodi Seadgens 3.5 saaTs, xolo misi klirensi daaxloebiT 0.6 ml/wuTSi/kg-is tolia.
filgrastimis uwyveti infuziis dros 28 dRis ganmavlobaSi avadmyofebSi Zvlis tvinis
autologiuri gadanergvis Semdeg ar aRiniSneba kumulaciis niSnebi da naxevargamoyofis periodis
gaxangrZliveba.
Cvenebebi
neitropeniis xangrZlivobis Semcirebis da febriluri neitropeniis sixSiris daqveiTebis mizniT
avadmyofebSi, romlebic itareben qimioTerapias citostaturi saSualebebiT avTvisebiani daavadebebis
gamo (qronikuli mieloleikozis da mielodisplaziuri sindromis gamoklebiT), aseve neitropeniis da
misi klinikuri Sedegebis xangrZlivobis Sesamcireblad avadmyofebSi, romlebic itareben
mieloablatiur Terapias Zvlis tvinis Semdgomi gadanergviT.
periferiul sisxlSi hemopoezis autologiuri ujredebis-winamorbedebis mobilizacia, maT Soris
mielosupresiuli Terapiis dros hemopoezis aRdgenis dasaCqareblad, am ujredebis SeyvaniT
mielosupresiis an mieloablatiis Semdeg.
xangrZlivi Terapia neitrofilebis ricxvis gazrdisaTvis da infeqciuri garTulebebis sixSiris da
xangrZlivobis Sesamcireblad bavSvebSi da mozrdilebSi mZime Tandayolili, perioduli an
avTvisebiani neitropeniiT (neitrofilebis absoluturi ricxvi 1 mm2-Si 500-ze naklebia) da anamnezSi
mZime an recidivuli infeqciebiT.
dozirebis reJimi
citotoqsiuri qimioTerapiis standartuli sqema:
0.5 mln. se (5 mkg/kg) erTxel dReSi.
mieloablaturi Terapia Zvlis tvinis Semdgomi gadanergviT:
sawyisi doza _ 1.0 mln. se (10 mkg/kg) dReSi intravenurad wveTovnad 30 wuTis an 24 saaTis
ganmavlobaSi, an 1.0 mln. se (10 mkg/kg) dReSi uwyveti kanqveSa infuziis saxiT 24 saaTis
ganmavlobaSi.
neipogenis pirveli dozis Seyvana xdeba citotoqsiuri Terapiis Catarebidan 24 saaTis Semdeg, xolo
Zvlis tvinis gadanergvis dros _ misi Catarebidan 24 saaTis Semdeg.
neitrofilebis
ricxvis
maqsimaluri
Semcirebisas
xdeba
dReRamuri
dozis
koreqtireba
neitrofilebis ricxvis dinamikis mixedviT. Tu neitrofilebis ricxvi ar aRemateba 1000/1 mm3 3 dRis
ganmavlobaSi, neipogenis doza mcirdeba 0.5 mln. se/kg/dReSi; SemdgomSi neipogeni ixsneba, Tu
neitrofilebis absoluturi ricxvi 3 dRis ganmavlobaSi aRemateba 1000/1 mm 3. Tu mkurnalobis
periodSi neitrofilebis ricxvi mcirdeba <1000/1 mm3, neipogenis doza izrdeba moyvanili sqemis
mixedviT.
periferiul sisxlSi hemopoezis ujredebis-winamorbedebis mobilizacia:
am mizniT qimioTerapiis gareSe _ 1.0 mln. se (10 mkg/kg) dReSi 24 saaTiani uwyveti intravenuri
infuziiT, an kanqveS SeyvaniT erTxel dReSi 6 dRis ganmavlobaSi. leikoferezis Catareba
rekomendebulia me-5, -6, -7 dRes.
am ujredebis mobilizaciis mizniT mielosupresuli qimioTerapiis Semdeg _ 0.5 mln. se (5 mkg/kg)
dReSi yoveldRiuri kanqveSa ineqciebis saxiT, romelic iwyeba qimioTerapiis damTavrebidan pirvelive
dRes da grZeldeba manamde, sanam neitrofilebis ricxvi ar gadaaWarbebs mosalodnel minimums da ar
miaRwevs normalur mniSvnelobas. leikoferezi tardeba im periodSi, rodesac neitrofilebis
absoluturi ricxvi imatebs <500-dan >5000 -ze/1 mm3. avadmyofebSi, romlebic ar itareben intensiur
qimioTerapias sakmarisia 1 leikoferezis Catareba, xolo sxva SemTxvevaSi rekomendebulia damatebiTi
leikoferezis Catareba.
mZime qronikuli neitropenia:
Tandayolili neitropenia: sawyisi doza _ 1.2 mln. se (12 mkg/kg) dReSi kanqveS erTjeradad, an ramdenime
Seyvanis saxiT.
idiopaTuri an perioduli neitropenia: 0.5 mln. se (5 mkg/kg) dReSi kanqveS erTjeradad an, ramdenime
Seyvanis saxiT.
gansakuTrebuli miTiTebebi dozirebis Sesaxeb:
klinikuri kvleva neipogenis gamoyenebis Sesaxeb xandazmulebSi ar aris Catarebuli, amitom ar aris
rekomendaciebi preparatis gamoyenebis Sesaxeb am asakobriv jgufSi.
neipogeniT mkurnaloba tardeba mxolod onkologis da hematologis meTvalyureobis qveS, romlebsac
gaaCniaT maTi gamoyenebis gamocdileba da aucilebeli diagnostikuri SesaZleblobebi.
ujredebis mobilizaciis da leikaferezis procedurebi tardeba onkologiur an hematologiur
centrSi, romlebsac gaaCniaT am proceduris Catarebis gamocdileba da hemopoezis ujredebiswinamorbedebis adeqvaturi monitoringis SesaZlebloba.
preparatis gamoyeneba bavSvebSi mZime qronikuli neitropeniiT da onkologiuri daavadebebiT:
klinikuri kvlevisas avadmyofTa 65%-s asakiT 18 wlamde aReniSneboda mZime qronikuli neitropenia.
am asakobriv jgufSi, sadac avadmyofTa umetesobas aReniSneboda
Tandayolili neitropenia,
mkurnaloba iyo efeqturi. amave dros, neipogenis usafrTxoebis profili bavSvebSi mZime qronikuli
neitropeniiT ar gansxvavdeba Cveulebrivisagan.
neipogenis efeqturoba da usafrTxoeba mozrdilebSi da bavSvebSi, romlebic itareben citotoqsikur
qimioTerapias erTnairia.
bavSvebSi rekomendaciebi dozirebis Sesaxeb iseTivea, rogorc mozrdilebSi, romlebic itareben
mielosupresul citotoqsikur qimioTerapias.
Seyvana:
avadmyofebSi, romlebic iReben standartul citotoqsikur qimioTerapias:
SesaZlebelia neipogenis Seyvana yoveldRiurad kanqveSa ineqciebis, an yoveldRiuri xanmokle (30
wuTi) intravenuri infuziebis saxiT glukozis 5% xsnarSi.
umetes SemTxvevaSi mizanSewonilia preparatis Seyvana kanqveS. preparatis erTjeradi Seyvanisas
Catarebuli kvlevis Sedegad dadginda, rom misi moqmedebis xangrZlivoba intravenuri Seyvanisas
ufro xanmoklea. am movlenis klinikuri mniSvneloba preparatis mravaljeradi Seyvanis dros
dadgenili ar aris. preparatis Seyvanis gzis arCeva damokidebulia konkretul klinikur situaciaze.
neipogenis pirveli doza SehyavT citotoqsikuri Terapiidan 24 saaTis Semdeg.
neipogeni SehyavT yoveldRiurad, sanam neitrofilebis ricxvi ar gadaaWarbebs mosalodnel minimums
da ar daubrundeba normalur mniSvnelobas. soliduri simsivneebis qimioTerapiis Semdeg, neipogeniT
mkurnalobis mosalodneli xangrZlivoba Seadgens 14 dRes. mwvave mieloleikozis induqciuri da
konsolidaciuri Terapiis Semdeg neipogeniT mkurnalobis xangrZlivoba ufro metia (38 dRe),
gamoyenebuli citotoqsikuri qimioTerapiis sqemis, tipis, dozebis mixedviT.
avadmyofebSi, romlebic itareben citotoqsikur qimioTerapias, neitrofilebis ricxvis gardamavali
momateba aRiniSneba neipogeniT mkurnalobis dawyebidan 1-2 dRis Semdeg. stabiluri Terapiuli
efeqtis misaRwevad aucilebelia neipogeniT mkurnalobis gagrZeleba, sanam neitrofilebis ricxvi ar
gadaaWarbebs mosalodnel minimums da ar miaRwevs normalur mniSvnelobas. ar aris rekomendebuli
neipogenis moxsna naadrevad, sanam neitrofilebis ricxvi ar gadaaWarbebs mosalodnel minimums.
avadmyofebSi, romlebic itareben citotoqsikur qimioTerapias da CautardaT Zvlis tvinis gadanergva,
neipogeni iniSneba kanqveS da intravenurad winaswari ganzavebiT 20 ml 5% glukozis xsnarSi.
neipogenis pirveli doza SehyavT citotoqsikuri qimioTerapiidan 24 saaTis Semdeg, xolo Zvlis
tvinis gadanergvis Semdeg _ araugvianes 24 saaTisa.
neipogenis gamoyenebis efeqturoba da
usafrTxoeba aseT situaciaSi ganisazRvreba araumetes 28 dRiT.
avadmyofebSi mZime qronikuli neitropeniiT neipogeni SehyavT yoveldRiurad kanqveS, sanam
neitrofilebis ricxvi stabilurad ar gadaaWarbebs 1500/1 mm3-Si. Terapiuli efeqtis miRwevisas unda
ganisazRvros minimaluri efeqturi doza am donis SesanarCuneblad.
amisaTvis aucilebelia preparatis yoveldRiuri xangrZlivi Seyvana. mkurnalobis 1-2 kviris Semdeg
sawyisi doza SeiZleba gaormagdes an ganaxevrdes avadmyofis reaqciis mixedviT. SemdgomSi 1-2 kviris
ganmavlobaSi xdeba sawyisi dozis individualuri koreqcia neitrofilebis ricxvis saSualo donis
SesanarCuneblad diapazonSi 1500-10000/1 mm3-Si. avadmyofebSi mZime infeqciebiT, SesaZlebelia dozis
ufro swrafi gazrdis sqemis gamoyeneba. klinikuri kvlevis dros 97% avadmyofebSi, romlebic
dadebiTad reagirebdnen mkurnalobaze, sruli Terapiuli efeqti aRiniSneboda neipogenis doziT
Seyvanisas 24 mkg/kg dReSi.
neipogenis gamoyenebis usafrTxoeba xangrZlivi mkurnalobisas avadmyofebSi mZime qronikuli
neitropeniiT doziT 24 mkg/kg dReSi dadgenili ar aris.
miTiTebebi ganzavebis Sesaxeb:
dauSvebelia neipogenis ganzaveba natriumis qloridis fiziologiur xsnarSi.
aucileblobisas neipogens anzaveben glukozis 5% xsnarSi. ganzavebuli neipogeni ganicdis absorbcias
SuSiT da plastmasiT. ganzavebuli preparati SeTavsebadia SuSasTan da rig plastmasebTan kerZod,
polivinilqloridTan, poliolefinTan (polipropilenis da polieTilenis sopolimeri) da
polipropilenTan. Tu neipogens ganazaveben koncentraciamde 1.5 mln se (15 mkg) 1 ml-Si, xsnars
umateben adamianis Sratis albumins, raTa saboloo koncentraciam Seadginos 2mg/ml-Si. magaliTad,
xsnaris saboloo moculobisas 20 ml, neipogenis jamuri dozebi 30 mln se-ze (300 mkg) naklebi
unda iqnas Seyvanili 0.2 ml 20% adamianis Sratis albuminis xsnaris damatebiT. dauSvebelia
preparatis ganzaveba mis saboloo koncentraciamde 0.2 mln se (2 mkg) 1 ml-Si.
gverdiTi movlenebi
avadmyofebi, romlebic itareben citotoqsikur qimioTerapias:
neipogeniT mkurnaloba rekomendebuli dozebiT xSirad iwvevs tkivilebs ZvlebSi da kunTebSi.
rogorc wesi, tkivilebi msubuqi an zomieri siZlierisaa (10%), xandaxan Zlieri (3%) da umetes
SemTxvevaSi kupirebas ganicdis Cveulebrivi analgeziuri saSualebebiT. iSviaTad aRiniSneba Sardvis
darRveva (ZiriTadad, msubuqi da zomieri dizuria). aRwerilia calkeuli SemTxvevebi arteriuli
wnevis gardamavali Semcirebis Sesaxeb, romelic mkurnalobas ar saWiroebs.
xSirad
aRiniSneba
Seqcevadi,
dozadamokidebuli
da
Cveulebriv
msubuqi
da
zomieri
laqtatdehidrogenazas, tute fosfatazas, Sratismieri Sardovanas da -glutamiltransferazas
aqtivobis momateba. randomizirebuli, placebo-kontrolirebadi klinikuri kvlevis dros dadgenili
iqna, rom neipogeni ar iwvevs gverdiTi reaqciebis sixSiris zrdas citotoqsikuri qimioTerapiis
Catarebisas.
gverdiTi movlenebi, romlebic erTnairi sixSiriT aRiniSneba avadmyofebSi, romlebsac
utardebaT neipogeni/qimioTerapia da placebo/qimioTerapia, moicavs gulisrevas, Rebinebas, alopecias,
diareas, moTenTilobas, anoreqsias, lorwovani garsebis anTebas, Tavis tkivils, xvelas, gamonayars
kanze, tkivils gulmkerdSi, saerTo sisustes, tkivils yelSi, yabzobas da araspecifikur tkivilebs.
xandaxan avadmyofebSi, romlebsac utardebaT qimioTerapia maRali dozebiT SemdgomSi Zvlis tvinis
autologiuri gadanergviT, aRiniSneboda sisxlZarRvovani darRvevebi (magaliTad, veno-okluziuri
daavadeba da wylis cvlis darRveva). maTi mizezobrivi kavSiri neipogenis gamoyenebasTan dadgenili
ar aris.
aRwerilia iSviaTi SemTxvevebi iseTi simptomebis ganviTarebis, romlebic miuTiTebs alergiuli tipis
reaqciebze. maTi umetesi nawili dakavSirebulia pirveli dozis miRebasTan, rac ganpirobebulia
preparatis intravenuri gamoyenebiT. mkurnalobis aRdgenisas xandaxan aRiniSneba simptomebis recidivi.
neipogenis daniSvna qimioTerapiis Semdeg, romlis sqemaSi Sedis bleomicini, iwvevs intersticiuli
pnevmoniis ganviTarebas, xandaxan letaluri gamosavaliT. misi mizezobrivi kavSiri neipogenis
gamoyenebasTan dadgenili ar aris.
avadmyofebSi mZime qronikuli neitropeniiT aRiniSneba gverdiTi movlenebis ganviTareba neipogenze,
mxolod zogierT pirebSi am simptomebis sixSire droTa ganmavlobaSi mcirdeba.
yvelaze xSiri gverdiTi movlenebi, romlebsac iwvevs neipogeni aris tkivili ZvlebSi da
generalizebuli tkivilebi ConCxis kunTebSi.
sxva gverdiTi movlenebi moicavs elenTis gadidebas, romelic zogierT avadmyofebSi progresirebs,
aseve Trombocitopenias. aRwerilia Tavis tkivili, diarea (10% naklebi). preparatis xangrZlivi
gamoyenebisas aRiniSneba anemia, sisxldena cxviridan.
zogjer aRiniSneba gardamavali da klinikurad usimptomo Sardovanas Sratismieri koncentraciis,
laqtatdehidrogenazas, tute fosfatazas aqtivobis momateba, aseve Wamis Semdeg sisxlSi glukozis
koncentraciis gardamavali Semcireba.
gverdiTi movlenebi aseve moicavs adgilobriv reaqcias ineqciis adgilas, Tavis tkivils, RviZlis
gadidebas, tkivils saxsrebSi, Tmebis cvenas, osteoporozs, gamonayars kanze.
xangrZlivi Terapiis dros 2% avadmyofebSi mZime qronikuli neitropeniiT adgili aqvs kanismieri
vaskulitis ganviTarebas, iSviaTad aRiniSneba-proteinuria da hematuria.
ukuCvenebebi
- momatebuli mgrZnobeloba preparatis mimarT;
- mZime Tandayolili neitropenia (kostmanis sindromi) citogenetikuri darRvevebiT.
dauSvebelia neipogenis daniSvna citostaturi qimioTerapiuli preparatebis dozebis gazrdis mizniT
rekomendirebulze ufro maRal dozebSi.
orsuloba da laqtacia
neipogenis usafrTxoeba orsul qalebSi dadgenili ar aris. preparatis gamoyeneba am periodSi
dasaSvebia mxolod im SemTxvevaSi, rodesac misi savaraudo Terapiuli efeqti aRemateba nayofze misi
moqmedebis risks.
gansakuTrebuli miTiTebebi
avTvisebiani ujredebis zrda:
adamianis granulacituli zrdis faqtors SeuZlia gamoiwvios mieloiduri ujredebis zrda in vitro.
analogiuri efeqti aRiniSneba in vitro zogierTi aramieloiduri ujredebis mimarT.
neipogenis gamoyenebis usafrTxoeba da efeqturoba mielodisplaziuri sindromis da qronikuli
mieloleikozis dros dadgenili ar aris, amitom am daavadebebisas aRniSnuli preparati naCvenebi ar
aris. gansakuTrebuli yuradReba unda mieqces diferenciul diagnozs qronikuli mieloleikozis
blastransformaciasa da mwvave leikozs Soris.
avadmyofebi, romlebic itareben citotoqsikur qimioTerapias:
leikocitozi: 5% nakleb avadmyofebSi, romlebic iReben neipogens doziT 0.3-ze mln se (3 mkg/kg
dReSi) mets, leikocitebis ricxvi izrdeba 100000-mde/1 mm3 da meti. gverdiTi movlenebi, romlebic
uSualod dakavSirebulia aseT leikocitozTan, aRwerili ar aris. Tumca gaTvaliswinebuli unda
iqnas SesaZlebeli riski, dakavSirebuli mZime leikocitozTan, ris gamoc neipogeniT mkurnalobis
dros aucilebelia leikocitebis ricxvis regularuli kontroli. Tu igi aRemateba 50000/1 mm3-Si,
neipogeni unda moixsnas. Tu neipogens niSnaven ujredebis-winamorbedebis mobilizaciis mizniT, mas
xsnian im SemTxvevaSi, Tu leikocitebis ricxvi aRemateba 100000/1 mm 3-Si.
riski, romelic dakavSirebulia qimioTerapiasTan maRali dozebiT:
aucilebelia gansakuTrebuli sifrTxile im avadmyofebSi, romlebic itareben qimioTerapias maRali
dozebiT, radganac am dros neoplazmis gamosavalis gaumjobeseba ar aRiniSneba, Tumca amave dros
qimiopreparatebis maRal dozebs gaaCnia gamoxatuli toqsikuroba, maT Soris movlenebi gulis,
filtvebis mxriv, aseve nevrologiuri da dermatologiuri reaqciebi.
monoTerapia
neipogeniT
ar
Trgunavs
Trombocitopenias,
anemias,
romelic
gamowveulia
mielosupresuli qimioTerapiiT. preparatis maRali dozirebis dros (magaliTad, sruli dozebi
sqemebis mixedviT), mosalodnelia Trombocitopeniis da anemiis ganviTarebis ufro maRali riski.
rekomendebulia Trombocitebis da hematokritis regularuli kontroli. aucilebelia sifrTxilis
dacva erTkomponentiani an kombinirebuli qimioTerapiuli sqemebis gamoyenebis dros, romlebic iwveven
mZime Trombocitopenias.
ujredebis-winamorbedebis gamoyeneba, romlebic mobilizebulni arian neipogenis saSualebiT, amcirebs
Trombocitopeniis gamoxatulebas da xangrZlivobas mielosupresuli an mieloablaturi qimioTerapiis
Semdeg.
avadmyofebi mZime qronikuli neitropeniiT:
transformacia leikozSi an preleikozSi: aucilebelia gansakuTrebuli sifrTxile mZime qronikuli
neitropeniis diagnostikis dros, raTa Catardes maTi diferencireba sxva hematologiur
daavadebebTan, rogoric aris aplaziuri anemia, mielodisplazia, mieloleikozi.
preparatiT
mkurnalobis dawyebamde aucilebelia sisxlis sruli analizis Catareba leikocituri formulis da
Trombocitebis raodenobis gansazRvriT; aseve ikvleven Zvlis tvinis morfologiur suraTs da
kariotips.
3% avadmyofebSi mZime Tandayolili neitropeniiT (kostmanis sindromi), romlebic iReben neipogens,
aRiniSneba mielodisplaziuri sindromi (mds) da leikozi. isini warmoadgenen am daavadebis
garTulebebs, Tumca maTi kavSiri neipogeniT mkurnalobasTan dadgenili ar aris.
12% avadmyofebSi sawyisi normaluri citogenetikiT ganmeorebiTi gamokvlevis dros aRiniSneba
anomalia, maT Soris monosomia 7. Tu avadmyofebSi kostmanis sindromiT aRiniSneba citogenetikuri
darRvevebi,
aucilebelia
ganisazRvros
neipogeniT mkurnalobis
sargeblianoba
da
riski.
mielodisplaziuri sindromis da leikozis ganviTarebis SemTxvevaSi aucilebelia neipogenis moxsna.
jer dadgenili ar aris iwvevs Tu ara neipogeniT mkurnaloba citogenetikuri garTulebebis
ganviTarebas.
avadmyofebSi kostmanis sindromiT rekomendebulia 12 TveSi
erTxel
Catardes Zvlis tvinis
morfologiuri da citogenetikuri kvlevebi.
sisxlis formula: neipogeniT mkurnalobis pirveli kviris ganmavlobaSi aucilebelia Trombocitebis
ricxvis kontroli. Tu ganviTarda Trombocitopenia (Trombocitebis ricxvi stabilurad dabalia
100000-ze 1 mm3-Si), unda ganxilul iqnas sakiTxi preparatis moxsnis, an dozis ESemcirebis Sesaxeb.
aseve aRiniSneba sisxlis formulis sxva cvlilebebi, rac iwvevs misi kontrolis aucileblobas, maT
Soris anemia da mieloiduri ujredebis-winamorbedebis gardamavali zrda.
sxva: unda gamoiricxos infeqciis iseTi mizezi, rogoric aris virusuli infeqcia. elenTis gadideba
warmoadgens neipogeniT mkurnalobis uSualo Sedegs. klinikuri kvlevis dros 31% avadmyofebSi mZime
qronikuli neitropeniiT palpaciiT aRiniSneboda splenomegalia. rentgenografiis dros misi
moculobis gazrda aRiniSneba mkurnalobis dawyebis Semdeg da gaaCnia tendencia stabilizaciisaken.
dadgenilia, rom dozis Semcireba anelebs, an aCerebs elenTis zrdas. 3% avadmyofebs esaWiroebodaT
spleneqtomia. elenTis zomebi kontrolirdeba regularulad. elenTis zomis dasadgenad aucilebelia
muclis palpacia.
mcirericxovan avadmyofebSi
aRiniSneba hematuria da proteinuria, maTi kontrolisaTvis
aucilebelia Sardis regularuli analizi.
preparatis gamoyenebis usafrTxoeba da efeqturoba axalSobilebSi da avadmyofebSi autoimunuri
neitropeniiT gamokvleuli ar aris.
avadmyofebi, romlebsac utardebaT hemopoezis ujredebis-winamorbedebis mobilizacia:
mobilizacia: randomizirebuli kvlevebi ori rekomendebuli mobilizaciis meTodebis Sesadareblad
(mxolod filgristimi an kombinaciaSi mielosupresul qimioTerapiasTan) avadmyofTa erTnair
kontigentze ar Catarebula. sxvaobis xarisxi calkeul avadmyofTa da CD34+ujredebis
laboratoriul gansazRvras Soris
adasturebs, rom sxvadasxva kvlevebis pirdapiri Sedareba
gaZnelebulia. amitom optimaluri meTodis rekomendacia Znelia. mobilizaciis meTodis SerCeva xdeba
aRniSnuli avadmyofis mkurnalobis saerTo miznis mixedviT.
winamorbedi mkurnaloba citotoqsikuri saSualebebiT: avadmyofebSi, romlebsac warsulSi CautardaT
aqtiuri mielosupresuli Terapia, SeiZleba ar moxdes ujredebis-winamorbedebis sakmarisi aqtivacia
minimalur donemde (2.0X106 CD34+/kg) an Trombocitebis ricxvis normalizaciis daCqareba.
zogierT citostatur saSualebebs gaaCniaT gansakuTrebuli toqsikuroba hemopoezis ujredebiswinamorbedebis mimarT da uaryofiTad moqmedeben maT mobilizaciaze. iseTma saSualebebma, rogoric
aris melfalani, karmustini da karboplatini, Tu isini iniSnebodnen xangrZlivi drois ganmavlobaSi
ujredebis-winamorbedebis mobilizaciamde, SeiZleba Seamciron misi efeqturoba. neipogenis
erTdrouli gamoyeneba melfalanTan, karboplatinTan an karmustinTan erTad efeqturia ujredebiswinamorbedebis aqtivaciisaTvis. Tu igegmeba periferiuli ujredebis-winamorbedebis gadanergva,
rekomendebulia daigegmos Rerovani ujredebis mobilizacia mkurnalobis adreul stadiaze.
gansakuTrebuli yuradReba unda mieqces ujredebis-winamorbedebis ricxvs, romlebic ganicdian
aqtivirebas avadmyofebSi maRali dozebiT qimioTerapiis Catarebamde. Tu mobilizaciis Sedegi, zeviT
moyvanili kriteriumebis Sesabamisad,
arasakmarisia, unda ganxilul iqnas mkurnalobis
alternatiuli saxeoba, romelic ar moiTxovs ujredebis-winamorbedebis gamoyenebas.
ujredebis-winamorbedebis Sefaseba: ujredebis-winamorbedebis ricxvis Sefasebisas, romlebic ganicdian
mobilizacias avadmyofebSi neipogeniT mkurnalobis dros, unda mieqces gansakuTrebuli yuradReba
raodenobriv meTods. CD34+ ujredebis ricxvis citometruli analizis Sedegi
gansxvavdeba
konkretuli meTodologiis Sesabamisad.
damokidebulebis statistikuri analizi Seyvanili CD34+ujredebis ricxvsa da Trombocitebis
raodenobis normalizacias Soris miuTiTebs rTul, magram stabilur damokidebulebaze.
sifrTxilis sxva zomebi:
avadmyofebSi Tanmxlebi Zvlovani paTologiiT da osteoporoziT, romlebsac utardebaT uwyveti
mkurnaloba neipogeniT 6 Tvis ganmavlobaSi, naCvenebia Zvlis nivTierebis simkvrivis kontroli.
kvleva neipogenis gamoyenebis Sesaxeb avadmyofebSi Tirkmelebis da RviZlis dazianebiT ar aris
Catarebuli, amitom misi daniSvna avadmyofTa am jgufSi rekomendebuli ar aris.
neipogenis moqmedeba avadmyofebSi mieloiduri ujredebis-winamorbedebis Semcirebis dros Seswavlili
ar aris. neipogeni zrdis neitrofilebis ricxvs ujredebis-winamorbedebze zemoqmedebiT. amitom
avadmyofebSi ujredebis-winamorbedebis SemcirebiT (magaliTad, intensiuri sxivuri Terapiis an
qimioTerapiis dros) neitrofilebis ricxvis momatebis xarisxi SeiZleba iyos dabali.
neipogenis zemoqmedeba reaqciaze `trasplantati maspinZlis winaaRmdeg~ dadgenili ar aris.
Warbi dozireba
neipogenis Warbi dozirebis Sesaxeb monacemebi ar moipoveba. preparatis miRebis Sewyvetidan 1-2 dRis
Semdeg cirkulaciaSi myofi neitrofilebis ricxvi mcirdeba 50%-iT da ubrundeba normas 1-7 dRis
Semdeg.
sxva wamlebTan urTierTqmedeba
neipogenis da mielosupresuli citostaturi qimiopreparatebis erTdrouli gamoyenebis usafrTxoeba
da efeqturoba ar aris dadgenili. imis gamo, rom aRiniSneba mgrZnobeloba swrafad gamyofi
mieloiduri ujredebis mxriv mielosupresuli qimioTerapiis mimarT, neipogenis daniSvna 24 saaTiT
adre am preparatebis Seyvanamde, an 24 saaTiT Semdeg ar aris rekomendebuli.
winaswari monacemebi avadmyofebis mcire ricxvis mixedviT, romlebic erTdroulad iReben neipogens
da 5-ftoruracils, adasturebs, rom neitropeniis simZimis xarisxi SeiZleba gaizardos. SesaZlebeli
urTierTqmedeba sxva hemopoezur zrdis faqtorTan da citokinebTan klinikuri kvleviT dadgenili ar
aris.
Senaxvis vada:
2 weli.
Senaxvis pirobebi:
ara umetes +2-8 0 C.
bavSvebisagan dacul adgilas.
ar SeiZleba vadagasuli preparatis gamoyeneba.
neipogenis ganzavebuli xsnari mzaddeba 24 saaTiT adre gamoyenebamde da inaxeba
macivarSi +2-80 C
temperaturaze. flakonebi neipogeniT gamoiyeneba mxolod
erTjeradad.
Sprici-tubi gankuTvnilia mxolod preparatis erTjeradi gamoyenebisaTvis.
SefuTva:
Sprici-tubi 1;
.
F. HOFFMANN-LA ROCHE