血液肿瘤儿童化疗后预防性使用重组人粒细胞/粒细胞-巨噬细胞集落刺激因子的疗效和安全性  

Prophylactic recombinant human granulocyte/granulocyte-macrophage colony-stimulating factor in children with hematologic malignancies after chemotherapy

作　　者：富洋[1] 王宏胜[1] 翟晓文[1] 钱晓文[1] 苗慧[1] 朱晓华[1] 俞懿[1] 

机构地区：[1]复旦大学附属儿科医院血液肿瘤科,上海201102

出　　处：《肿瘤》2017年第5期504-510,共7页Tumor

摘　　要：目的:探讨血液肿瘤患儿化疗后预防性使用重组人粒细胞/粒细胞巨噬细胞集落刺激因子(recombinant human granulocyte/granulocyte-macrophage colony-stimulating factor,rhG/GM-CSF)的疗效及不良反应。方法:比较血液肿瘤患儿接受强烈化疗后24~48 h预防性使用rhG/GMCSF后,中性粒细胞绝对值(absolute neutrophil count,ANC)恢复时间、感染发生率及不良反应。结果:2013年1月—2015年12月符合标准的预防性使用rhG/GM-CSF共248例次。ANC平均恢复时间为11.6 d(95%可信区间:11.1~12.0 d),单用rhG-CSF组为10.8 d(95%可信区间:10.1~11.4 d),单用rhGMCSF组为12.7 d(95%可信区间:11.9~13.4 d)。rhG-CSF组中性粒细胞水平恢复时间较rhGM-CSF组短(z=-4.649,P<0.01)。急性髓细胞白血病患者中性粒细胞水平的恢复时间较高危急性淋巴细胞白血病/淋巴母细胞型淋巴瘤和B细胞型非霍奇金淋巴瘤患者迟(z=4.819,P<0.01;z=5.595,P<0.01)。含大剂量阿糖胞苷方案组的中性粒细胞水平恢复时间较其他方案显著延长(z=5.417,P<0.01)。单用rhG-CSF组和单用rhGM-CSF组发热性中性粒细胞缺乏发生率分别为58.9%和57.8%,2组差异无统计学意义(P=0.87)。HR3方案治疗最易引起感染,发热性中性粒细胞缺乏发生率高达88.0%。感染相关死亡患者2例,其中单用rhGCSF组1例,为B细胞型非霍奇金淋巴瘤患者接受BB方案治疗后因脓毒血症而放弃治疗;另一例为单用rhGM-CSF,为高危急性淋巴细胞白血病患者接受HR3方案后发生耐药铜绿假单胞菌败血症而死亡。结论:血液肿瘤患儿化疗后预防性使用rhG/GM-CSF的安全性较好。今后,需要开展较大样本量的随机对照试验以证实预防性使用rhG/GM-CSF对降低化疗后感染发生率的价值。Objective： To analyze the efficacy and adverse effects of post-chemotherapy prophylactic recombinant human granulocyte/granulocyte-macrophage colony-stimulating factor （rhG/ GM-CSF） in children with hematologic malignancies. Methods： The time of neutrophil recovery and the incidence rates of infection and adverse events of prophylactic use of rhG/GM-CSF within 24-48 h after chemotherapy in children with high-risk acute lymphoblastic leukemia/lymphoblastic lymphoma （HR-ALL/LBL）, acute myeloid leukemia （AML） or B-cell non-Hodgkin＇s lymphoma （B-NHL） were compared. Results： There were 248 cases included in this study between January 2013 and December 201 5. The average time for the patients to recover their neutrophils was 11.6 d [95% confidence interval （C/）： 11.1-12.0 d] for all patients, 10.8 d （95% CI： 10.1-11.4 d） for those treated with rhG-CSF, and 12.7 d （95% CI： 11.9-13.4 d） for rhGM-CSF. The neutrophil recovery time of rhG-CSF group was significantly shorter than that of rhGM-CSF group （z = 4.649, P 〈 0.01）. AML patients recovered neutrophils later than patients with HR-ALL/LBL （z = 4.819, P 〈 0.01） and B-NHL （z = 5.595, P 〈 0.01）. Patients treated with protocols containing high-dose cytosine arabinoside, whose neutrophil recovery time was significantly longer than the patients in other protocol groups （z = 5.41 7, P 〈 0.01）. There was 58.9% of patients in rhG-CSF group had febrile neutropenia （FN）, and the rate of FN for rhGM-CSF was 57.8%; there had no statistical difference between the two groups （P = 0.87）. HR3 protocol led to the highest FN rate （88.0%） among all protocols. Infection-related deaths in 2 patients were recorded, one in rhG-CSF group and suffered from B-NHL who later developed sepsis after BB protocol, and the other patient had HR-ALL and was in rhGM-CSF group, who was treated with HR3 protocol and died of multi-drug resistant pseudomonas aeruginosa sepsis. Conclusion： The post-chemotherapy prophylactic use o

关 键 词：血液肿瘤 粒细胞集落刺激因子 粒细胞-巨噬细胞集落刺激因子 感染 儿童 治疗 

分 类 号：R733.7[医药卫生—肿瘤]