格拉诺赛特对肺癌化疗后所致白细胞减少的治疗

本文报道了由日本中外制药生产的rhG－CSF(格拉诺赛特Granocyte)治疗肺癌化疗后白细胞减少及其不良反应。1 材料与方法1．1 临床资料 回顾性选自本院1996～1998年住院肺癌患者9例,均经组织学或细胞学证实,分别为鳞癌3例、小细胞未分化癌4例、腺癌2例,无严重的心、肝、肾器质性疾病。分别选用CE、CAP、COAP方案给予治疗,化疗剂量按每平方米计算。 辅助检查：血常规化疗前1次,化疗后每周2次,化疗前后检查肝、肾功能及心电图、体温测量。1．2 rhG－CSF使用方法 化疗过程中白细胞在3．0×109／L以下时加用rhG－CSF 200μg／d,…     

应用格拉诺赛特治疗肺癌化疗患者的白细胞减少症

肺癌化疗过程中，经常引起患者严重的骨髓抑制，造成中性粒细胞绝对值（ＡＮＣ）减少，当ＡＮＣ＜０．５×１０９／Ｌ时，常出现高热、感染、败血症而危及生命。用日本中外制药株式会社生产的格拉诺赛特（ｒｈＧ－ＣＳＦ）对化疗药物所致的白细胞减少症进行治疗，有增加中...     

高低剂量格拉诺赛特预防消化系癌化疗后白细胞减少症

目的观察格拉诺赛特(GranocyterhG-CSF)高低剂量预防化疗引起白细胞减少的观察效果.方法用药参照原来白细胞下降的程度,在化疗后48小时先给予格拉诺赛特,待白细胞正常用量减半,停药设对照周期观察.30例消化系癌在第一周期化疗后,白细胞＜4.0×109/L时,对照给格拉诺赛特治疗用药升白,作为对照周期.于第二周期化疗结束后48小时预防给药,每日皮下注射格拉诺赛特100μg,用3～5日后,当白细胞升至>10.0×109/L,剂量减半,再用5～7日,总用药10日.结果30例中,男性13例,女性17例.食管癌1例,胃癌12例,肠癌9例,肝癌3例,胰腺癌5例.全部30例,总有效率100%(有效率100%,无效率0).全组只有1例用药第2天出现不良作用.结论参照对第一周期化疗的患者白细胞下降程度,于第二周期化疗结束后48小时用高低剂量的格拉诺赛特,可有效防止白细胞下降,升白疗效好,效果稳定.     

低剂量格拉诺赛特(rtG-CSF)防治卵巢癌化疗后白细胞减少症的疗效观察

目的:探讨低剂量格拉诺赛特(rhG-CSF)的不同用法对卵巢癌化疗后白细胞和中性粒细胞减少的防治作用。方法:43例的上皮性卵巢癌化疗患者随机分为3组,其中,A组(共66疗程)不用rhG-CSF;B组(共57疗程)为白细胞计数<2.0×109/L时给予rhG-CSF,C组(共73疗程)自化疗结束后48小时起给予rhG-CSF,剂量均为50μg/日,皮下注射。结果:C组白细胞最低值的持续时间明显短于A和B组,分别为白细胞计数10日;中性粒细胞计数11日(P<0.01),平均最低值分别为3.01×109/L和0.986×109/L。B和C组rhG-CSF的作用并不随年龄、体重和化疗次数而改变。结论:rhG-CSF可以维持白细胞和中性粒细胞的水平,早期应用G-CSF可能会增大化疗剂量或缩短化疗间歇时间,从而提高化疗强度。     

低剂量格拉诺赛特（rhG—CSF）防治淋巴瘤化疗后白细胞减少症的 …

探讨低剂量格拉诺赛特（ｒｈＧ－ＣＳＦ）对淋巴瘤ＣＨＯＰＥ化疗后白细胞和中性细胞减少的防治作用，采用随机分组，自身交叉对比的方法，患者随机分为Ａ，Ｂ两组，Ａ组第一周期化疗后加ｒｈＧ－ＣＳＦ，第二周期单用化疗，Ｂ组第一周期单用化疗，第二周期化疗后加ｒｈＧ－ＣＳＦ，ｒｈＧ－ＣＳＦ在化疗药物末次给药后４８ｈ起，５０μｇ／日，皮下注射，结果表明，该剂量的ｒｈＧ－ＣＳＦ可以明显减轻化疗过程中的白细胞和中性粒细     

格拉诺赛特对这妆,复治肺癌化疗致白细胞减少的恢复作用

联合化疗可提高小细胞和非小细胞肺癌的疗效 ,但化疗药物的毒副反应 ,骨髓抑制 ,常给继续化疗带来困难。据报道 ,人粒细胞集落刺激因子 (ｒｈＧ ＣＳＦ)具有与人体Ｇ ＣＳＦ相同氨基酸的序列和糖链组分 ,刺激骨髓中的粒系造血干细胞分化和增殖 ,缩短化疗引起的白细胞下降的恢复期。本文报告由日本中外制药公司生产的ｒｈＧ ＣＳＦ(格拉诺赛特 ,Ｇｒａ ｎｏｃｙｔｅ)对 80例初、复治肺癌化疗患者的骨髓保护作用及其不良反应。1　材料与方法1 1　临床资料回顾性选自 1996年 2月～ 1999年 2月本院住院肺癌患者 80例 ,均经组织学或细胞学证实 ,…     

格拉诺赛特在实体瘤化疗中的应用

应用格拉诺赛特预防和治疗化疗引起的白细胞减少。方法：预防用药组：末次化疗结束４８～７２小时给格拉诺赛特５０～１００μｇ,皮下,ｑｄ,５～１４天;治疗组在白细胞计数低于３０×１０９／Ｌ后给格拉诺赛特１００～２００μｇ,皮下,ｑｄ,５～１４天。结果：预防用药组５４个周期白细胞计数均在４０×１０９／Ｌ以上,占７５％（５４／７２）;１８个周期白细胞计数低至（１８～３９）×１０９／Ｌ之间,占２５％（１８／７２）,但持续时间不超过５天,均不影响下一周期化疗的实施。治疗组给格拉诺赛特前白细胞计数平均１６×１０９／Ｌ,治疗平均５２天后白细胞计数上升至４０×１０９／Ｌ以上。结论：格拉诺赛特是预防和治疗化疗引起的白细胞减少的有效药物。     

格拉诺赛特治疗恶性肿瘤大剂量化疗引起的中性粒细胞减少症的临 …

目的：观察了５９例恶性肿瘤患者大剂量化疗后引起的中性粒细胞减少症。方法;分别用不同剂量的格拉诺赛特进行治疗。结果;格拉诺赛特剂量与疗效呈正相关。对Ⅱ度白细胞减低患者用５０μｇ／日,Ⅲ度白细胞减低者用１００μｇ／日;Ⅳ度白细胞减低者用１５０－２００ｇ／日为宜。结论;低剂量时疗效确切,能短时间内使中性粒细胞回升到正常水平,防止感染发生。     

国产G-CSF治疗门诊化疗患者的白细胞减少

目的:评价rhG-CSF(国产瑞白)治疗门诊患者化疗后白细胞减少的作用和不良反应。方法:52例患者,均为病理或细胞学证实的恶性肿瘤。在化疗后白细胞计数<2.9×109/L时给予rhG-CSF(国产瑞白)100μg,每日1次,皮下注射,连续5天。结果:rhG-CSF(国产瑞白)100μg,每日1次,连续5天。治疗后可明显增加门诊患者化疗后的白细胞计数,使化疗按期完成,不同原发肿瘤、转移部位、既往是否化疗以及不同化疗方案之间均无显著差别。结论:rhG-CSF(国产瑞白)100μg,每日1次,皮下注射连用5天是门诊化疗患者有价值的辅助治疗手段。     

乳腺癌患者多西他赛药时曲线下面积与中性粒细胞减少的相关性

目的 研究乳腺癌患者化疗后,多西他赛（docetaxel, DTX）药时曲线下面积（area under curve, AUC）与血液学毒性（中性粒细胞减少）的相关性,为患者个体化给药提供理论依据。方法 选择郑州大学附属肿瘤医院2016年12月—2017年7月接受AC序贯T化疗方案的94例乳腺癌患者,采用胶乳免疫比浊法测定患者静脉输注DTX后的血药浓度,并通过非混合效应模型软件计算多西他赛AUC。建立利用AUC预测化疗后中性粒细胞减少百分比的数学模型。结果 多西他赛AUC在（0.7~3.9）mg·h/L之间,平均值为（2.34±0.7）mg·h/L,患者间AUC的变异系数（CV%）为30%。出现低级别（0~2级）及高级别（3~4）中性粒细胞减少的AUC平均值分别为2.29 mg·h/L和2.82 mg·h/L （P=0.003）。利用多西他赛AUC预测中性粒细胞减少百分比的模型为y=-1.8672x2+25.658x-14.92, r=0.643。结论 本研究建立的利用AUC预测中性粒细胞减少百分比的数学模型,为通过测定患者AUC进行多西他赛个体化的给药提供了理论依据。     

Neutropenia as a Predictive Factor in Metastatic Colorectal Cancer Treated With TAS-102

Background

TAS-102 significantly improves overall survival in patients with metastatic colorectal cancer. The most common treatment-related adverse event of TAS-102 is bone marrow suppression, which leads to neutropenia. The potential predictive value of neutropenia caused by cytotoxic drugs has been reported in various types of cancer.

Analysis of Factors Associated With In-hospital Mortality in Lung Cancer Chemotherapy Patients With Neutropenia

Lung cancer, compared with other solid tumors, is associated with high mortality rates from febrile neutropenia. The risk factors associated with in-hospital mortality were identified and compared for patients with lung cancer and patients with other solid tumors. Hospitalization data from the University Health Consortium database inclusive of 2004 to 2012 were analyzed. The study population included all adult patients with solid tumors who developed neutropenia. Cancer type, the presence of neutropenia, and further subgroups were determined using International Classification of Diseases, 9th revision, Clinical Modification codes. The primary study outcome was in-hospital mortality in lung cancer patients versus those with other solid tumors. Further analysis concentrated on comparisons of the 2 groups. The analysis included data from 11,111 lung cancer patients and 49,975 patients with other solid tumors. Overall, 4290 patients (7.0%) died. Lung cancer was associated with highest mortality (11.2% compared with other solid tumors, 6.1%; P < .0001). The lung cancer patients were older and more likely to have multiple comorbidities, and the risk of mortality was directly related to the number of comorbidities. Four additional risk factors for mortality were identified: pneumonia, sepsis, any infection, and intensive care unit stay. Pneumonia occurred more commonly in the lung cancer patients (26.4% vs. 10.3%) and was associated with comorbid pulmonary disease, which also occurred more often in the lung cancer patients (52.1% vs. 24.0%). We found that lung cancer patients presenting with febrile neutropenia were older, had more comorbidities, had a greater incidence of comorbid pulmonary disease, and were more likely to have pneumonia. Awareness of these risk factors for mortality should guide clinicians for more personalized approaches to chemotherapy, supportive care decisions, pneumonia and comorbidities.     

Antibiotic Management of Febrile Neutropenia: Current Developments and Future Directions

Abstract

Mortality due to febrile neutropenia has decreased since the concept of empiric therapy became standard care. However, infections complications remain the most common adverse events of chemotherapy. Bacterial epidemiology has changed during the past decades. There is currently an increasing trend in infections due to Gramnegative bacteria which have higher rates of resistance for a variety of reasons.

The use of biomarkers for diagnosis remains a domain of further investigation. Since the patient population with febrile neutropenia is very heterogeneous, models of risk assessment have been developed with the most commonly used today being the MASCC score.

Oral antibiotic treatment seems to be appropriate in low-risk patients. In moderate or high-risk patients monotheraphy is the most common option. However, due to emerging resistance this could change by next year, Some new antibiotics have been developed, but experiences in the treatment of neutropenic fever is limited. The use of antibiotics for prophylaxis remains controversial, although recent studies suggest a reduction in death from all causes.     

预防性使用PEG-rhG-CSF在有营养风险的局部晚期非小细胞肺癌化疗后中性粒细胞缺乏中的疗效

目的 探讨预防性使用聚乙二醇重组人粒细胞刺激因子（PEG-rhG-CSF）在有营养风险的局部晚期非小细胞肺癌（NSCLC）患者化疗期间中性粒细胞缺乏中的有效性和安全性。方法 选取有营养风险的局部晚期NSCLC患者337例。随机分为未预防性使用药物组112例（对照组）、预防性使用rhG-CSF治疗组112例（rhG-CSF治疗组）和预防性使用PEG-rhG-CSF治疗组113例（PEG-rhG-CSF治疗组）。观察化疗后中性粒细胞减少症的发生率和持续时间以及外周血中CD4+/CD8+T细胞的比值。结果 对照组、rhGCSF治疗组和PEG-rhG-CSF治疗组中性粒细胞减少症发生率分别为67.97%、41.57%和37.98%（P<0.05）；Ⅲ~Ⅳ度中性粒细胞减少症发生率分别为22.39%、14.25%和11.14%（P<0.05）；中性粒细胞减少性发热发生率分别为3.55%、1.84%和1.21%（P<0.05）；外周血中CD4⁺/CD8⁺T细胞比值分别为1.27±0.44、1.32±0.52和1.49±0.25（P<0.05）。PEG-rhG-CSF治疗组Ⅲ~Ⅳ度中性粒细胞减少症持续时间和中性粒细胞值从最低值到2.0×10⁹/L以上所需时间均低于对照组和rhG-CSF治疗组（P<0.05）。结论 预防性使用PEG-rhG-CSF能降低有营养风险的局部晚期NSCLC化疗期间中性粒细胞减少症的发生率，增强患者免疫功能。     

恶性肿瘤患者化疗所致中性粒细胞减少与其疗效的相关性

目的探讨恶性肿瘤患者术后化疗过程中出现中性粒细胞减少与其无瘤生存期的相关性。方法回顾性分析136例术后辅助化疗恶性肿瘤患者的临床资料。结果中性粒细胞减少组/缺乏组无瘤生存期与无中性粒细胞减少组比较有显著差异（P〈0.05）,中性粒细胞减少组无瘤生存期与中性粒细胞缺乏组比较无显著差异（P〉0.05）。结论恶性肿瘤患者化疗过程中出现中性粒细胞减少,与其无瘤生存期明显相关,而未出现中性粒细胞减少者可能提示药物剂量不足。