The clinical impact of primary granulocyte-colony stimulating factor prophylaxis in children with acute lymphoblastic leukemia who underwent induction chemotherapy.

IF 4.5 2区 医学 Q2 IMMUNOLOGY
Yi-An Lu, Hsi-Che Liu, Jen-Yin Hou, Nan-Chang Chiu, Ting-Huan Huang, Ting-Chi Yeh
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引用次数: 0

Abstract

Background: Data describing the risk factors for the occurrence of severe infections in acute lymphoblastic leukemia (ALL) patients following induction chemotherapy and the role of prophylactic granulocyte-colony stimulating factor (G-CSF) in the era of antimicrobials prophylaxis are limited.

Methods: This study enrolled 188 children aged ≤18 years with newly diagnosed ALL who received Taiwan Pediatric Oncology Group ALL-2002 and 2013 treatments between January 1, 2010 and June 30, 2021. Prophylactic G-CSF was administered when a patient continues neutropenia after achieving the first bone marrow remission since June 1, 2015. Clinical factors were assessed for their association with severe infections.

Results: From January 2010 to May 2015, 80 children experienced a total of 11 (13.5%) episodes of severe infections; while 10 (9.2%) episodes were reported to occur in 108 patients who received prophylactic G-CSF. Reduction of severe infections occurrence did not achieve statistical significance during prophylactic G-CSF administration in ALL patients. Compared with ALL-high risk (HR) and very high risk patients with no G-CSF prophylaxis, the use of G-CSF prophylaxis significantly reduced episodes of febrile neutropenia. Occurrence of grade III-IV intestinal ileus, grade II-III oral mucositis, prolonged neutropenia, central venous catheter (CVC) placement, or the requirement insulin therapy for hyperglycemia were associated with higher risk of bloodstream infections.

Conclusions: ALL-HR patients with G-CSF prophylaxis were associated with reduction of febrile neutropenia episodes. Occurrence of severe ileus, oral mucositis, hyperglycemia, CVC placement, or prolonged neutropenia were associated with severe infections in ALL patients receiving induction chemotherapy.

对接受诱导化疗的急性淋巴细胞白血病患儿进行初级粒细胞集落刺激因子预防的临床影响。
背景:描述急性淋巴细胞白血病(ALL)患者在诱导化疗后发生严重感染的风险因素以及预防性粒细胞集落刺激因子(G-CSF)在抗菌药物预防时代的作用的数据十分有限:本研究招募了188名年龄小于18岁的新确诊ALL患儿,他们在2010年1月1日至2021年6月30日期间接受了台湾儿科肿瘤学组ALL-2002和2013治疗。自2015年6月1日以来,患者在获得首次骨髓缓解后,如果继续出现中性粒细胞减少症,则会使用预防性G-CSF。对临床因素与严重感染的关系进行了评估:从2010年1月到2015年5月,80名儿童共发生了11次(13.5%)严重感染;而在108名接受预防性G-CSF的患者中,据报告发生了10次(9.2%)严重感染。在ALL患者预防性使用G-CSF期间,严重感染发生率的降低并没有统计学意义。与未使用 G-CSF 预防性治疗的 ALL 高危(HR)和极高危患者相比,使用 G-CSF 预防性治疗可显著减少发热性中性粒细胞减少症的发生。发生III-IV级肠回肠炎、II-III级口腔粘膜炎、中性粒细胞减少时间延长、中心静脉导管(CVC)置入或因高血糖需要胰岛素治疗与较高的血流感染风险有关:结论:ALL-HR患者接受G-CSF预防治疗可减少发热性中性粒细胞减少症的发生。在接受诱导化疗的ALL患者中,出现严重回肠炎、口腔黏膜炎、高血糖、CVC置入或中性粒细胞减少时间延长与严重感染有关。
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来源期刊
Journal of Microbiology Immunology and Infection
Journal of Microbiology Immunology and Infection IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
15.90
自引率
5.40%
发文量
159
审稿时长
67 days
期刊介绍: Journal of Microbiology Immunology and Infection is an open access journal, committed to disseminating information on the latest trends and advances in microbiology, immunology, infectious diseases and parasitology. Article types considered include perspectives, review articles, original articles, brief reports and correspondence. With the aim of promoting effective and accurate scientific information, an expert panel of referees constitutes the backbone of the peer-review process in evaluating the quality and content of manuscripts submitted for publication.
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