Pegfilgrastim的时间:与儿童实体和中枢神经系统肿瘤人群发热性中性粒细胞减少症的关系。

IF 1.9 3区 医学 Q2 NURSING
Journal of Pediatric Oncology Nursing Pub Date : 2021-11-01 Epub Date: 2021-08-17 DOI:10.1177/10434542211037729
Laura Schlenker, Renee C B Manworren
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引用次数: 2

摘要

背景:虽然推荐的给药时间为化疗后≥24小时,但患者对第二天给药的障碍、现有的成人证据和药代动力学数据导致一些患有实体和中枢神经系统肿瘤的儿科患者更早给药。本研究的目的是通过化疗后pegfilgrastim的使用时间来比较患者的预后。方法:回顾性分析182例0 ~ 29岁患者932次给药时间。主要终点为发热性中性粒细胞减少症(FN);次要终点为中性粒细胞减少延迟(ND)至下一个化疗周期≥7天。为了解释每位患者多次给药聚非格昔汀,使用广义混合模型,二分类结果(FN和ND)采用logit链接,时间作为二分类自变量,患者随机效应。结果:916个周期中有196个发生FN (21.4%);805个周期中有19个周期为ND(2.4%)。化疗后<或≥24 h给药pegfilgrastim固定效果不显著,p = 0.50;但早于或晚于20 h有显著性意义,p = 0.005。讨论:虽然化疗后≥24小时应尝试给药pegfilgrastim,但如果存在障碍,应考虑根据患者个体特征修改时间。需要前瞻性随机试验来确定早期给药pegfilgrastim的低风险患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Timing of Pegfilgrastim: Association with Febrile Neutropenia in a Pediatric Solid and CNS Tumor Population.

Background: While recommended timing of pegfilgrastim administration is ≥24 h after chemotherapy, patient barriers to next day administration, available adult evidence, and pharmacokinetic data have led to earlier administration in some pediatric patients with solid and central nervous system tumors. The purpose of this study was to compare patient outcomes by timing of pegfilgrastim after chemotherapy. Methods: A retrospective chart review examined timing of 932 pegfilgrastim administrations to 182 patients, 0-29 years of age. The primary outcome was febrile neutropenia (FN); the secondary outcome was neutropenic delays (ND) ≥7 days to next chemotherapy cycle. To account for multiple pegfilgrastim administrations per patient, a generalized mixed model was used with a logit link for the dichotomous outcomes (FN & ND), timing as the dichotomous independent variable, and random effect for patient. Results: FN occurred in 196 of 916 cycles (21.4%); and ND in 19 of 805 cycles (2.4%). The fixed effect of pegfilgrastim administration < or ≥24 h after chemotherapy was not significant, p = .50; however, earlier or later than 20 h was significant, p = .005. FN odds were significantly higher when pegfilgrastim was given <20 h (OR 1.78, 95% CI: 1.19-2.65) after chemotherapy, which may be attributable to differences in chemotherapy toxicity regardless of pegfilgrastim timing. Discussion: While attempts should be made to administer pegfilgrastim ≥24 h after chemotherapy, if barriers exist, modified timing based on individual patient characteristics should be considered. Prospective randomized trials are needed to identify lower risk patients for early pegfilgrastim administration.

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
0
审稿时长
>12 weeks
期刊介绍: SPECIAL PATIENTS NEED SPECIAL NURSES Caring for children with cancer is one of the most technically and emotionally difficult areas in nursing. Not only are you dealing with children and adolescents who hurt, you must reassure and educate families, balance a multitude of other health care professionals, and keep up with ever-changing nursing practice and care. To help special nurses stay aware of the newest effective nursing practices, innovative therapeutic approaches, significant information trends, and most practical research in hematology and pediatric oncology nursing, you need the Journal of Pediatric Oncology Nursing. The journal offers pediatric hematology, oncology, and immunology nurses in clinical practice and research, pediatric social workers, epidemiologists, clinical psychologists, child life specialists and nursing educators the latest peer-reviewed original research and definitive reviews on the whole spectrum of nursing care of childhood cancers, including leukemias, solid tumors and lymphomas, and hematologic disorders. JOPON covers the entire disease process--diagnosis, treatment, recovery, and survival, as well as end-of-life care. Six times a year, the Journal of Pediatric Oncology Nursing introduces new and useful nursing care practice and research from around the world that saves you time and effort. Just some of the spirited topics covered include: Cancer survivorship including later-life effects of childhood cancer, including fertility, cardiac insufficiency, and pulmonary fibrosis Combination therapies Hematologic and immunologic topics Holistic, family-centered supportive care Improvement of quality of life for children and adolescents with cancer Management of side effects from surgery, chemotherapy, and radiation Management of specific symptoms/diseases/co-infections Medication tolerance differences in children and adolescents Pain control Palliative and end of life care issues Pharmacologic agents for pediatrics/clinical trial results Psychological support for the patient, siblings, and families The dynamic articles cover a wide range of specific nursing concerns, including: Advanced practice issues Clinical issues Clinical proficiency Conducting qualitative and quantitative research Developing a core curriculum for pediatric hematology/oncology nursing Encouraging active patient participation Ethical issues Evaluating outcomes Professional development Stress management and handling your own emotions Other important features include Guest Editorials from experts in the discipline, Point/Counterpoint debates, Roadmaps (personal insights into the nursing experience), and Proceedings and Abstracts from the annual Association for Pediatric Hematology/Oncology Nurses (APHON) conference. Your special patients need special nurses--stay special by subscribing to the Journal of Pediatric Oncology Nursing today! This journal is a member of the Committee on Publication Ethics (COPE).
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