聚乙二醇化重组人G-CSF在以CHOP为基础方案的非霍奇金淋巴瘤中的应用

背景与目的：由环磷酰胺、长春新碱、多柔比星和泼尼松组成的CHOP方案是侵袭性非霍奇金淋巴瘤(non-Hodgkin's lymphoma, NHL)的标准化疗方案，其发生粒细胞减少性发热(febrile neutropenia, FN)的风险为10%~20%。近年来聚乙二醇化粒细胞集落刺激因子(pegylated recombinant human granulocyte colony stimulating factor, PEG-rhG-CSF)在临床中逐渐广泛应用。该研究旨在明确PEG-rhG-CSF在接受CHOP方案为基础化疗的非霍奇金淋巴瘤患者中预防性应用的疗效和安全性。方法：该研究回顾性分析了75例患者，其中36例接受了初级预防，39例接受了次级预防，所有患者均完成所有治疗并纳入数据分析。结果：在初级预防组中，52.8%的患者未再发生4度中性粒细胞缺乏或FN，63.9%未导致化疗减量。在次级预防组，61.5%的患者未再发生4度中性粒细胞缺乏或FN，66.7%未导致化疗减量。多因素分析显示，高龄(大于等于65岁)和3/4期是预防后仍然出现严重中性粒细胞缺乏并导致化疗减量的独立高危因素。安全性方面，短暂的腰骶部1~2级疼痛是主要的不良反应。结论：PEG-rhG-CSF的预防性应用不但使用方便，并且显示了良好的预防效果和耐受性，值得临床推荐。

Use of pegylated G-CSF in non-Hodgkin lymphoma with CHOP-based chemotherapy

Background and purpose: CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) is the standard chemotherapy regimen for aggressive non-Hodgkin lymphoma (NHL), which has a 10%-20% rate of febrile neutropenia (FN). Recently, pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) is frequently used in clinical practice. Our study aimed to investigate the efficacy and safety of prophylactic PEG-rhG-CSF in patients with non-Hodgkin lymphoma on CHOP-based chemotherapy. Methods: In this study, we retrospectively analyzed the clinical data of 75 patients. of whom 36 received primary prophylaxis, 39 received secondary prophylaxis. All patients completed their treatment and were included in data analysis. Results: In primary prophylaxis group, 52.8% patients did not have grade 4 or FN and 63.9% completed their treatment without dose reduction. In secondary prophylaxis group, 61.5% patients did not have grade 4 or FN and 66.7% completed their treatment without dose reduction. Multivariate analysis showed that old age (≥65 years) and stage 3/4 were independent factors for serious neutropenia and dose reduction. In regard to the safety profiles, transient grade 1-2 lumbosacral pain was the main adverse effect. Conclusion: Prophylactic use of PEG-rhG-CSF is not only convenient but also efficacious and well tolerated. Therefore, its routine clinical application is recommended.