非格司亭治疗化疗后中性粒细胞减少疗效观察

目的:观察非格司亭对化疗后中性粒细胞减少的疗效.方法:恶性淋巴细胞增生性疾病患者68例,分为治疗组40例,分别以EACOP方案及VDP L方案化疗后,应用非格司亭150 μg,iv,5 d或sc,4～14 d.观察其血清粒细胞集落刺激因子(G CSF)浓度及骨髓AKP积分.对照组28例,单用化疗,未用非格司亭.结果:与对照组相比,治疗组中性粒细胞数恢复时间治疗组缩短(P＜0.05),感染机会减少(P＜0.05),但化疗期病死率未见降低.部分病例发现骨髓AKP积分增高、血清 G CSF浓度增高.结论:非格司亭促进化疗后中性粒细胞恢复疗效明显,并减少继发感染的机会,副作用小.     

白血病患儿医院感染相关因素调查

目的探讨白血病患儿医院感染的临床特点及易感因素。方法选取白血病患儿242例,回顾其临床资料,从年龄、性别、住院时间、化疗阶段等方面观察比较,研究其发生医院感染的几率。结果患儿医院感染发生率与住院时间、白细胞计数和是否进行诱导、巩固化疗有关。年龄、性别、预防性应用抗生素等并不影响白血病患儿医院感染率;白血病患儿医院感染多见于上呼吸道、口腔、下呼吸道;医院感染会增加白血病患儿病死率。结论白血病患儿医院感染率高,掌握其危险因素,给予适当、有效、合理的措施有助于降低白血病患儿医院感染发生率。     

儿童急性淋巴细胞白血病医院感染临床分析

目的：了解人住普通病房急性淋巴细胞白血病（急淋）患儿诱导缓解及强化治疗期间医院感染的发生频率、感染部位、病原菌类型。方法：分析30例儿童急淋医院感染临床资料。结果：急淋患儿医院感染率为86．7％，医院感染部位以下呼吸道占首位，其次为上呼吸道、胃肠道、口腔、皮肤、血液、泌尿道；病原菌以G^-杆菌多见，其次为球菌、真菌；≤3岁儿童医院感染率多于3岁以上儿童；急淋诱导化疗期及强化治疗期易患医院感染，其中诱导缓解期较强化治疗阶段感染率高。结论：急淋患儿医院感染发生率高，医院感染发生与患儿年龄、治疗阶段有关，常见细菌为G^-菌。     

急性白血病患者诱导化疗阶段医院感染分析

<正>随着化疗和造血干细胞移植的进展,急性白血病的生存期已明显延长,但急性白血病患者免疫功能低下,易发生医院感染,危及患者生命,国内报道急性白血病医院感染发生率为37.9%~80.6%[1-3]。其中,诱导缓解阶段医院感染率远比巩固强化阶段高[4]。并且医院感染往往迫使化疗     

基于FAERS数据库的非格司亭不良事件信号挖掘与分析

目的 挖掘并分析非格司亭相关不良事件的信号,为该药的临床安全使用提供参考依据。方法 收集FAERS中的2013年1月1日—2023年12月31日关于非格司亭的不良事件数据,采用比例失衡法中的ROR、PRR和BCPNN法进行信号挖掘,对报告频数和信号强度排名前20位以及各系统器官分类的不良事件进行统计分析。结果 共收集非格司亭相关的不良事件报告数4 434份,挖掘到相关信号328个,以发热、骨痛、白细胞计数降低等较为常见;共涉及22个系统器官,主要集中在血液及淋巴系统疾病、感染及侵染类疾病、各类检查等。挖掘到78个说明书未记录的新发现可疑不良反应,以脓毒症、恶性肿瘤、骨整合不充分为主。结论 非格司亭在真实世界中发生的常见不良反应与说明书有一致性,但存在部分新发现可疑的不良反应,临床用药宜密切关注,做好患者用药前风险评估,用药后及时监测,以保证患者用药安全。     

大剂量化疗治疗白血病的观察与护理

白血病是一种原因不明的造血系统的恶性疾病。白血病的化疗过程为两个阶段,即诱导缓解及巩固维持治疗。笔者曾对20例白血病患者在普通环境下进行中、大剂量化疗,结果无明显感染及并发症,取得较满意的疗效,现将护理体会报告如下:     

小儿白血病院内感染特点分析及防治对策

目的探讨白血病患儿化疗抑制期医院感染的特点分析及防治对策。方法对1997年1月-2003年5月发生医院感染的白血病患儿的感染部位、感染因素及感染种类等作回顾性分析。结果发生医院感染的白血病患儿占32.3％，感染部位以呼吸道感染最多，感染种类以细菌为主。真菌感染有明显上升趋势，感染多发生在诱导缓解阶段，与白细胞降低程度成正比，外部环境改善后医院感染率明显降低，广谱联合抗生素的使用是增加感染的危险因素。结论白血病患儿医院感染机率较高，作好基础护理，加强保护性隔离，必要时置层流床、合理使用粒细胞刺激因子及抗生素，改善医院环境，积极预防卡氏肺囊虫及真菌感染等是防治白血病患儿医院感染的重要措施。     

急性白血病100例化疗治疗疗效研究

目的:探索连续三周化疗法治疗急性白血病的疗效。方法:收集2003年～2018年急性白血病患者100例,其中急性淋巴细胞白血病(ALL)38例,应用方案COMP,COAP三周疗法;急性非淋巴细胞白血病(ANLL)62例,应用方案HOAP,COAP或COMP三周疗法,并给予DA方案作强化,鞘内注射MTX,防治脑膜白血病,坚持巩固、维持治疗3年。结果:本组病例治疗期内总显效率达89.47%、ANLL达95.16%, CR率为62%,其中临床治愈、生存达10年以上者3例,中位生存达28月。结论:连续三周化疗法治疗急性白血病是经济、有效的方法之一,加强化疗期间的感染控制及支持对症治疗,并坚持巩固、维持治疗,消灭残留白血病细胞,可进一步提高疗效和生存率。     

乌体林斯和开瑞坦治疗小儿哮喘的临床研究

目的探讨乌体林斯(草分枝杆菌F.U.36)和开瑞坦联合治疗小儿哮喘的疗效。方法临床缓解期哮喘患儿118例随机分为治疗组和对照组,治疗组给予乌体林斯和开瑞坦,对照组给予开瑞坦,两组均常规吸入糖皮质激素,在急性发作期给予抗感染,经压缩泵吸入H2-R激动剂等强化治疗,观察半年内哮喘患儿呼吸道感染次数、哮喘发作次数、喘息天数、咳嗽天数、抗生素使用天数,并观察比较两组患儿治疗前后T细胞亚群的变化。结果治疗组患儿在半年内呼吸道感染次数、哮喘发作次数、喘息天数、咳嗽天数、抗生素使用天数均明显减少,经统计学检验,差异有统计学意义(P<0.05)。结论联合应用乌体林斯和开瑞坦治疗小儿哮喘比单用开瑞坦疗效显著。     

降钙素原与C反应蛋白在指导新生儿肺部感染抗生素使用中的价值探讨

目的:探讨降钙素原与C反应蛋白在指导新生儿肺部感染抗生素使用中的价值.方法:纳入的研究对象为该院2018年2月—2020年2月期间收治的80例肺部感染患儿,采用随机抽签的方式,将患儿分为2组,每组各40例,其中一组命名为对照组,根据患儿症状体征及血清C反应蛋白水平等指导抗生素使用,另外一组命名为观察组,根据检测患儿血清降钙素原水平指导抗生素使用,对比两组抗生素使用时间、抗生素药物费用、住院天数、住院费用,分析治疗过程中的降钙素原及C反应蛋白水平变化情况.结果:与对照组比较,观察组的抗生素使用时间及住院天数更短,抗生素药物费用及住院费用更低(P<0.05);治疗过程中动态监测患儿的降钙素原及C反应蛋白水平可发现,降钙素原下降明显,且每阶段两两比较均存在差异(P<0.05);C反应蛋白水平整体也呈下降趋势,但不能完全反应判断炎症控制情况及治疗效果,入院第1天的C反应蛋白水平与入院第3天比较,无统计学差异(P>0.05).结论:针对肺部感染患儿,实时监测降钙素原水平指导抗生素治疗较监测C反应蛋白水平更优,可减少抗生素滥用情况发生,缩短抗生素使用时间,节省抗生素药物费用及住院费用,缩短住院天数,可见降钙素原可作为抗生素治疗的定量指标,值得推广.     

白血病患儿医院感染及抗菌药物应用分析

目的：分析白血病患儿医院感染发生情况和抗菌药物使用情况。方法：对2013年我院儿科收治的193例白血病患儿医院感染情况和抗菌药物使用情况进行回顾性分析。结果：我院白血病患儿医院感染的发生率为71.5％（138／193）,白血病患儿中性粒细胞数≤0．5X10^9/L．医院感染的发生率为87．6％,明显高于中性粒细胞数〉0．5×10^9／L者。感染部位主要为呼吸道．感染病原菌以革兰阴性杆菌为主。抗菌药物选用以三代头孢菌素为主。结论：白血病患儿医院感染率高．医院感染的发生与粒细胞缺乏情况以及持续时间密切相关,应在治疗原发病的同时,合理使用抗菌药物,以有效降低和控制医院感染的发生。     

白血病住院患儿的抗菌药物用药分析

目的 分析急性白血病患儿感染发生情况和抗菌药物的使用情况.方法 对2011年新疆维吾尔自治区人民医院儿科收治的200例白血病患儿感染情况和抗菌药物使用情况进行回顾性分析.结果 我院急性白血病患儿感染的发生率为72.5％(145/200),当白血病患儿WBC≤1×109/L时,感染发生率为69.0％ (116/168),住院时间＞30 d时,其感染率为83.6％(61/73).检出病原菌以革兰阴性杆菌为主,感染部位以呼吸道最多,占74.2％.抗菌药物以三代头孢菌素选择频次最多,占29.9％.白血病患儿发生感染与自身外周血中性粒细胞下降水平和患儿入院时间的长短等因素相关(P＜0.05或P＜0.01).结论 急性白血病患儿感染率高,感染发生与患儿治疗阶段等因素有关,应在治疗原发病的同时,合理使用抗生素,以有效降低感染的发生率.     

Treatment of acute myeloid leukemia during the second and third trimesters of pregnancy

Fortunately, the occurrence of acute myeloid leukemia (AML) during pregnancy is rare. We report a case of successful fetal outcome with standard induction and consolidation treatment in the second and third trimesters, respectively. A 37-year-old woman in her second trimester (21 wks) of pregnancy was found to have acute myeloid leukemia. She elected to maintain the pregnancy and underwent induction with cytarabine and idarubicin. Her hospital course was complicated by Pseudomonas vesicularis and gram-positive bacilli (not Bacillus anthracis) septicemia, but she obtained complete remission. After discharge, a fetal echocardiogram at 26 weeks revealed a mildly dilated right ventricle with mild systolic dysfunction, and the left ventricle appeared smaller than normal with mild systolic dysfunction. The patient then received consolidation therapy with high-dose cytarabine. On day 14 of consolidation, filgrastim 16 mug/kg was added to improve stem cell mobilization. A total of 19.8x10(6) CD34+ cells/kg were collected with a single apheresis session. At 37 weeks, she delivered a viable female infant weighing 3 lbs 12 oz. Fetal abnormalities included acrocyanosis, shallow sacral dimple, short digits and limbs, and prominent frontal skull with mild macrognathia. A postnatal echocardiogram revealed a moderate-sized membranous ventricular septal defect. The ventricular septal defect proved significant and required surgical repair at 5 months. Approximately 4 weeks after delivery, the mother underwent autologous peripheral stem cell transplantation. Unfortunately, 100 days after transplantation, she had a relapse of AML. After a brief remission from a second induction, the patient died.     

Comparison of lenograstim and filgrastim on haematological effects after autologous peripheral blood stem cell transplantation with high-dose chemotherapy

OBJECTIVE: To compare the efficacy of lenograstim and filgrastim on haematological recovery following an autologous peripheral blood stem cell transplantation (PBSCT) with high-dose chemotherapy. METHODS: A retrospective case-controlled study. RESULTS: Absolute neutrophil count (ANC) recovery above 0.5 x 10(9)/l and white blood cell (WBC) recovery above 4 x 10(9)/l for 3 consecutive days was achieved earlier with filgrastim than with lenograstim ((13.2 +/- 8.0 vs 19.0 +/- 10.0 days, p = 0.004), (16.9 +/- 9.7 vs 29.9 +/- 16.6 days, p = 0.001), respectively). The platelet recovery above 20 x 10(9)/l was also achieved earlier with filgrastim than with lenograstim (19.5 +/- 11.6 vs 27.2 +/- 13.8 days, p = 0.006). Furthermore, filgrastim-treated patients received fewer days of granulocyte colony simulating factor (G-CSF) administration (12.5 +/- 7.0 vs 18.6 +/- 8.5 days, p = 0.001) and spent less time in hospital (23.7 +/- 10.9 vs 32.0 +/- 17.6 days, p = 0.009). Duration of antibiotic administration was also significantly shorter in the filgrastim group (13.6 +/- 7.6 vs 29.1 +/- 19.8 days, p = 0.001). CONCLUSION: In patients undergoing PBSCT following high-dose chemotherapy, filgrastim significantly reduced the duration of neutropenia, thrombocytopenia and days of G-CSF administration, and led to earlier hospital discharge compared with lenograstim.     

Economic analysis of filgrastim use for patients with acute myeloid leukaemia in the UK: a comparison of collection methods of resource use data

BACKGROUND: A clinical trial of patients with de novo acute myeloid leukaemia (AML) showed that haematopoietic support with filgrastim (granulocyte colony-stimulating factor, G-CSF) following induction and consolidation chemotherapy accelerated recovery from neutropenia. The clinical benefits included reductions in infections, anti-infective therapy and length of hospital stay. OBJECTIVE: The objective of this economic analysis is 2-fold. First, it aims to determine if the observed clinical benefits from the use of filgrastim would lead to cost savings from the perspective of a healthcare institution in the UK. Second, the analysis compares the results of two methods on collection of resource use data. DESIGN: A retrospective cost-minimisation analysis was undertaken based on the clinical results of all UK patients enrolled in the trial. Two cost models were developed: a model based only on the medical resource use collected in the case report forms (the CRF model); and a model based on all medical resources collected from patient medical files (the PF Model). Treatment costs of AML between filgrastim and the placebo arm were compared for the first induction cycle as well as the first induction and the first consolidation cycles combined. Results from the two models were compared. SETTING AND PATIENTS: The CRF model was applied to two samples of patients: all UK patients (n = 82) and patients enrolled at one centre [the Manchester Royal Infirmary (MRI) (n = 30)], whereas the PF model was applied to the MRI patient sample only. RESULTS: For all UK patients, using the CRF model, the filgrastim-treated arm produced cost savings of 747 pounds sterling (9.0%) and 2135 pounds sterling (14.4%) [1998 values] per patient in the first induction cycle and in the induction and consolidation cycles combined, respectively. For the patients at MRI the CRF model resulted in cost savings with filgrastim of 177 pounds sterling (2.2%) and 414 pounds sterling (3.2%) per patient respectively. Using the PF model the savings at MRI were 910 pounds sterling (8.6%) and 1285 pounds sterling (8.0%) per patient, respectively. CONCLUSION: Use of filgrastim in the treatment of AML in the UK may result in net cost savings. A retrospective analysis using total resources obtained through patient files produced higher cost savings estimates than that obtained by resources noted in the CRFs. The models based on PF resource data may be more reliable because they are more comprehensive. However, the cost estimates in this study may have been impacted by sample size, site characteristics, disease and treatment settings. Therefore, further evaluation on the methods for collecting resource use data in larger, multicentred studies is warranted.     

Comparative safety of filgrastim versus sargramostim in patients receiving myelosuppressive chemotherapy

STUDY OBJECTIVE: To compare rates of adverse events with filgrastim versus sargramostim when given prophylactically to patients receiving myelosuppressive chemotherapy. DESIGN: Retrospective review with center crossover. SETTING: Ten United States outpatient chemotherapy centers. PATIENTS: Four hundred ninety patients treated for lung, breast, lymphatic system, or ovarian tumors. INTERVENTION: Prophylactic use of filgrastim or sargramostim, with dosages at investigator discretion. MEASUREMENTS AND MAIN RESULTS: The frequency and severity of adverse events and the frequency of switching to the alternative CSF were assessed. There was no difference in infectious fever. Fever unexplained by infection was more common with sargramostim (7% vs 1%, p<0.001), as were fatigue, diarrhea, injection site reactions, other dermatologic disorders, and edema (all p<0.05). Skeletal pain was more frequent with filgrastim (p=0.06). Patients treated with sargramostim switched to the alternative agent more often (p<0.001). CONCLUSION: Adverse events were less frequent with filgrastim than with sargramostim, suggesting that quality of life and treatment costs also may differ.     

The role of myelopoietic growth factors in managing cancer in the elderly

More than 50% of all malignancies are diagnosed in patients aged > 65 years and most cancer-related deaths occur in this population. Misconceptions about prognosis and treatment contribute to the undertreatment of elderly cancer patients and consequent poor outcomes. Although older patients have been excluded from cancer treatment trials in the past, response rates to chemotherapy in a variety of common cancers in otherwise healthy elderly patients are comparable to those attained in younger patients. Lower functional reserve in many organ systems alters the pharmacokinetics of chemotherapeutic drugs as well as the patient's response to treatment-induced toxicity. Except for myelosuppression and mucositis, otherwise fit elderly cancer patients are not at significantly enhanced risk of toxicity to chemotherapy. Severe neutropenia and related infection are encountered much more frequently during the treatment of elderly as compared with younger cancer patients. These lead to treatment delays, dose reductions and higher hospitalisation rates. Myelopoietic growth factor support reduces myelosuppression and the associated risk of severe infection, thereby allowing delivery of chemotherapy at full dose intensity. Beneficial responses to granulocyte colony-stimulating factor (G-CSF; filgrastim) in elderly patients have been found in aggressive non-Hodgkin's lymphoma with standard cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) therapy and acute myeloid leukaemia (AML) during induction and consolidation chemotherapy. Granulocyte-macrophage colony-stimulating factor (GM-CSF; sargramostim) has been found to reduce myelosuppression in elderly AML patients receiving induction but not consolidation chemotherapy. These prophylactic treatments produce significant cost benefits because of the reduced hospitalisation and antibiotic use associated with neutropenia. To maximise positive outcomes, elderly patients should be included in clinical trials of new cancer agents. Since myelosuppression is the main risk factor for elderly patients undergoing chemotherapy, optimisation of growth factor support and the development of more effective and safer myelopoietic agents may improve success rates and reduce adverse events. Such information will lead to better management of cancer in older patients.     

Comparison of lenograstim and filgrastim on haematological effects after autologous peripheral blood stem cell transplantation with high-dose chemotherapy

SUMMARY

Objective: To compare the efficacy of lenograstim and filgrastim on haematological recovery following an autologous peripheral blood stem cell transplantation (PBSCT) with high-dose chemotherapy.

Methods: A retrospective case-controlled study.

Results: Absolute neutrophil count (ANC) recovery above 0.5?×?10⁹?l^?1 and white blood cell (WBC) recovery above 4?×?10⁹?l^?1 for 3 consecutive days was achieved earlier with filgrastim than with lenograstim ((13.2?±?8.0 vs 19.0?±?10.0 days, p?=?0.004), (16.9?±?9.7 vs 29.9?±?16.6 days, p?=?0.001), respectively). The platelet recovery above 20 x 10⁹/l was also achieved earlier with filgrastim than with lenograstim (19.5?±?11.6 vs

27.2?±?13.8 days, p?=?0.006). Furthermore, filgrastim-treated patients received fewer days of granulocyte colony simulating factor (G-CSF) administration (12.5?±?7.0 vs 18.6?±?8.5 days, p?=?0.001) and spent less time in hospital (23.7?±?10.9 vs 32.0?±?17.6 days, p?=?0.009). Duration of antibiotic administration was also significantly shorter in the filgrastim group (13.6?±?7.6 vs 29.1?±?19.8 days, p?=?0.001). Conclusion: In patients undergoing PBSCT following high-dose chemotherapy, filgrastim significantly reduced the duration of neutropenia, thrombocytopenia and days of G-CSF administration, and led to earlier hospital discharge compared with lenograstim.     

大剂量阿糖胞苷治疗儿童急性淋巴细胞白血病的疗效观察

目的:观察大剂量阿糖胞苷(Ara-C)治疗儿童急性淋巴细胞白血病(ALL)的临床疗效。方法:选择我院2003年11月-2006年11月收治的50例ALL患者,均分为治疗组和对照组。在常规诱导方案联合化疗达到完全缓解后,治疗组给予HD(H:高三尖杉酯碱;D:柔红霉素)联合大剂量Ara-C巩固治疗,对照组仅给予HD巩固治疗。观察、比较2组的临床疗效,患者化疗结束后1、3、5年内的无病生存率及不良反应。结果:治疗组总有效率为88.0%,显著高于对照组(44.0%),2组比较差异有统计学意义(χ2=4.399,P<0.05);治疗组1、3、5年的无病生存率分别为88.0%、64.0%、32.0%,对照组分别为48.0%、20.0%、0,治疗组均显著高于对照组(χ2分别为4.116、5.439、6.821,P<0.05);2组在治疗过程中均出现不同程度的骨髓抑制和胃肠道反应,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论:大剂量Ara-C方案巩固治疗儿童ALL临床疗效及安全性较好,可以显著延长患者的无病生存期。     

Prognostic factors in adult patients with acute leukemia

An analysis of prognostic factors was performed on a series of 50 adult patients with acute leukemia, treated in our department in the Tokai university Hospital between July, 1975 and June, 1980. The diagnosis was made in all cases on the basis of May-Grünwald-Giemsa-stained smears of peripheral blood and bone marrow. The patients were treated with two successive protocols. One course of induction chemotherapy consisted of 40 units/kg/day of neocarzinostatin, 1.2-1.6 mg/kg/day of cytosine arabinoside, 0.6-0.8 mg/kg/day of daunorubicin and 0.8-1.6 mg/kg/day of prednisolone on days 1-4 for acute nonlymphocytic leukemia, and the other consisted of 0.04 mg/kg/day of vincristine on day 1, 0.6-0.8 mg/kg/day of daunorubicin on days 1-4, 0.8-1.6 mg/kg/day of prednisolone on days 1-4 for acute lymphocytic leukemia. Consolidation and intensification therapies were given every 1-2 months after complete remission, and the protocols were basically the same as those of the induction therapy. Maintenance therapy consisted of 1.2-1.6 mg/kg/day of cytosine arabinoside, twice a week or 2 mg/kg/day of 6 MP orally. Risk factor leading to poor prognosis of acute leukemia were considered to be (1) advanced age (older than 50 years, P less than 0.05), (2) M5 (monocytic leukemia), (3) thrombocytopenia (less than 50,000 cmm-1), and (4) chromosome abnormalities of blast cells.