化疗引起的发热性中性粒细胞减少症的预防和管理:骨髓生长因子的作用

J. Dimitrijevic, M. Stojanović
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引用次数: 0

摘要

发热性中性粒细胞减少症是一种与化疗相关的严重不良事件,可导致并发症和死亡,并可能成为卫生保健系统组织的重大负担。发热性中性粒细胞减少的危险是由化疗诱导的骨髓抑制和患者相关危险因素决定的。在文献中,考虑了各种与患者相关的危险因素。患者的年龄是影响其预后的重要因素之一。如果估计发热性中性粒细胞减少的风险很高,建议预防性使用骨髓生长因子(粒细胞集落刺激因子和粒细胞-巨噬细胞集落刺激因子)。在实体瘤和淋巴瘤患者中,预防性使用髓样生长因子可显著降低发热性中性粒细胞减少症的发生率、化疗期间的早期死亡率和感染引起的死亡率。在发生发热性中性粒细胞减少症的患者中,与预防性使用相比,髓细胞生长因子的治疗性使用证据较少,尽管在减少中性粒细胞计数恢复时间方面有明显的益处。对于住院病人来说,缩短住院时间也有明显的好处。发热性中性粒细胞减少症患者以前未接受预防性髓系因子治疗,建议评估并发症的危险因素。对于高危发热性中性粒细胞减少患者,应考虑使用生长治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prophylaxis and management of chemotherapy-induced febrile neutropenia: The role of myeloid growth factors
Febrile neutropenia is a serious chemotherapy-related adverse event that can lead to complications and death and it could be a significant burden on the organization of the health care system. The risk for febrile neutropenia is determined by chemotherapy-induced myelosuppression and the presence of patient-related risk factors. In the literature, various patient-related risk factors are taken into consideration. It was suggested that the patient age is the one of the most important ones. If the estimated risk for the febrile neutropenia is high, prophylactic use of myeloid growth factors (granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor) is recommended. In patients with solid tumors and lymphomas it was shown that the prophylactic use of myeloid growth factors significantly reduces the incidence of febrile neutropenia, early mortality during chemotherapy and infection-induced mortality. In patients who develop febrile neutropenia, there is less evidence for the therapeutic use of myeloid growth factors compared to prophylactic use, although there is a clear benefit in reducing the time to neutrophil count recovery. There is a clear benefit for hospitalized patients, also, in reducing duration of hospitalization. In patients with febrile neutropenia who have not been previously treated with prophylactic myeloid factors, assessment of risk factors for the complications is advised. In patients with high-risk febrile neutropenia therapeutic use of growth should be considered.
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