Intragumtornchai T, Sutheesophon J, Sutcharitchan P, Swasdikul D
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Leuk Lymphoma. 2000 Apr;37(3-4):351-60. doi: 10.3109/10428190009089435.
The purpose of this study was to develop a model for predicting the occurrence of life-threatening neutropenia (LN, ANC < or = 0.5 x 10(9)/l) and febrile neutropenia (FN, an ANC < 0.5x10(9)/l in association with a body temperature of > or = 38.3 degrees C) after the first cycle of CHOP therapy in patients newly diagnosed with aggressive NHL. One hundred and forty-five patients, aged > or = 15 years, with newly diagnosed diffuse mixed, diffuse large-cell or large-cell immunoblastic lymphoma (IWF categories, F, G, H), who had been treated with CHOP at King Chulalongkorn Memorial Hospital between June 1994 and December 1998, were entered into the study. The criteria for eligibility included complete work-up for baseline evaluation, treatment with standard CHOP chemotherapy, at least one complete blood count performed during days 8-14 post-treatment or if at any time the patients experienced a BT of > or = 38.3 degrees C and were not treated with any colony-stimulating factors (CSFs). The median age of the patients was 47 years (range, 17-78). Forty-eight percent of the patients were in stage III/IV, 36% had ECOG performance status (PS) II-IV, 30% had > or = 2 extranodal diseases, 59% had serum LDH > 1 x normal and 23% had bone marrow involvement. The frequencies of patients in the low-, low-intermediate, high-intermediate and high risk groups according to the international index were 29%, 28%, 17% and 26%, respectively. Thirty-nine percent of the patients had LN at nadir and 33% developed FN after the first course of CHOP. By using stepwise logistic regression analysis, the pretreatment variables independently predictive of the LN at nadir and the FN were serum albumin concentration of < or = 3.5 g/dl, serum LDH > 1 x normal and whether there was bone marrow involvement of lymphoma at presentation. The model, based on the incorporation of these three factors, identified three risk groups of patients with a predicted probability of developing LN at nadir of 81.5% (95% CI, 68.5-90.7) (high risk), 23.9% (95% CI, 12.6-38.8) (intermediate risk) and 4.4% (95% CI, 0.5-15.1) (low risk). The predicted rate of FN in the three groups were 72.2% (95% CI, 58.4-83.5), 17.4% (95% CI, 7.8-31.4) and 2.2% (95% CI, 0.05-11.8), respectively. In conclusion, our model could be used as a means to identify patients with newly diagnosed aggressive NHL, treated with CHOP, who are at high risk (> or = 50% probability) of developing post-first course LN and FN, in whom CSF and/or antibiotic prophylaxis might be indicated.
本研究的目的是建立一个模型，用于预测新诊断的侵袭性非霍奇金淋巴瘤（NHL）患者在接受CHOP方案首个疗程治疗后发生危及生命的中性粒细胞减少（LN，中性粒细胞绝对值[ANC]≤0.5×10⁹/L）和发热性中性粒细胞减少（FN，ANC＜0.5×10⁹/L且体温≥38.3℃）的情况。1994年6月至1998年12月期间在朱拉隆功国王纪念医院接受CHOP治疗的145例年龄≥15岁、新诊断为弥漫性混合、弥漫性大细胞或大细胞免疫母细胞淋巴瘤（IWF分类，F、G、H）的患者纳入本研究。入选标准包括进行全面的基线评估、采用标准CHOP化疗方案治疗、治疗后第8 - 14天至少进行一次全血细胞计数，或者患者在任何时间体温≥38.3℃且未接受任何集落刺激因子（CSF）治疗。患者的中位年龄为47岁（范围17 - 78岁）。48%的患者处于Ⅲ/Ⅳ期，36%的患者东部肿瘤协作组（ECOG）体能状态（PS）为Ⅱ - Ⅳ级，30%的患者有≥2个结外病变，59%的患者血清乳酸脱氢酶（LDH）＞正常上限1倍，23%的患者有骨髓受累。根据国际预后指数，低、低中、高中和高风险组患者的比例分别为29%、28%、17%和26%。39%的患者在最低点时出现LN，33%的患者在首个CHOP疗程后发生FN。通过逐步逻辑回归分析，独立预测最低点时LN和FN的预处理变量为血清白蛋白浓度≤3.5 g/dl、血清LDH＞正常上限1倍以及初诊时淋巴瘤是否有骨髓受累。基于这三个因素的模型确定了三组风险患者，最低点时发生LN的预测概率分别为81.5%（95%可信区间[CI]，68.5 - 90.7）（高风险）、23.9%（95% CI，12.6 - 38.8）（中风险）和4.4%（95% CI，0.5 - 15.1）（低风险）。三组患者中FN的预测发生率分别为72.2%（95% CI，58.4 - 83.5）、17.4%（95% CI，7.8 - 31.4）和2.2%（95% CI，0.05 - 11.8）。总之，我们的模型可作为一种方法，用于识别新诊断的接受CHOP治疗的侵袭性NHL患者中，首个疗程后发生LN和FN风险高（概率≥50%）的患者，这些患者可能需要CSF和/或抗生素预防治疗。
