Lyman Gary H
Health Services and Outcomes Research, James P. Wilmot Cancer Center, University of Rochester, School of Medicine and Dentistry, Rochester, New York, USA.
Oncology (Williston Park). 2003 Nov;17(11 Suppl 11):8-13.
Myelosuppression and neutropenia represent the major dose-limiting toxicity of cancer chemotherapy. Chemotherapy-induced neutropenia may be accompanied by fever, presumably due to life-threatening infection, which generally requires hospitalization for evaluation and treatment with empiric broad-spectrum antibiotics. The resulting febrile neutropenia is a major cause of the morbidity, mortality, and costs associated with the treatment of patients with cancer. Furthermore, the threat of febrile neutropenia often results in chemotherapy dose reductions and delays, which can compromise long-term clinical outcomes. Prophylactic colony-stimulating factor (CSF) has been shown to reduce the incidence, severity, and duration of neutropenia and its complications. Guidelines from the American Society of Clinical Oncology recommend the use of CSF on the basis of the myelosuppressive potential of the chemotherapy regimen. The challenge in ensuring the appropriate and cost-effective use of prophylactic CSF is to determine which patients would be most likely to benefit from it. A number of patient-, disease-, and treatment-related factors are associated with an increased risk of neutropenia and its complications. A number of clinical predictive models have been developed from retrospective datasets to identify patients at greater risk for neutropenia and its complications. Early studies have demonstrated the potential of such models to guide the targeted use of CSF to those patients who are most likely to benefit from the early use of these supportive agents. Additional prospective research is needed to develop more accurate and valid risk models and to evaluate the efficacy and cost-effectiveness of model-targeted use of CSF in high-risk patients.
骨髓抑制和中性粒细胞减少是癌症化疗的主要剂量限制性毒性。化疗引起的中性粒细胞减少可能伴有发热，推测是由于危及生命的感染所致，这种情况通常需要住院进行评估并用经验性广谱抗生素治疗。由此产生的发热性中性粒细胞减少是癌症患者治疗相关发病率、死亡率和成本的主要原因。此外，发热性中性粒细胞减少的威胁常常导致化疗剂量减少和延迟，这可能会影响长期临床结果。预防性集落刺激因子（CSF）已被证明可降低中性粒细胞减少及其并发症的发生率、严重程度和持续时间。美国临床肿瘤学会的指南建议根据化疗方案的骨髓抑制潜力使用CSF。确保预防性CSF合理且具有成本效益使用的挑战在于确定哪些患者最有可能从中受益。一些与患者、疾病和治疗相关的因素与中性粒细胞减少及其并发症的风险增加有关。已经从回顾性数据集中开发了一些临床预测模型，以识别中性粒细胞减少及其并发症风险更高的患者。早期研究已经证明了此类模型在指导将CSF有针对性地用于最有可能从早期使用这些支持性药物中受益的患者方面的潜力。需要更多的前瞻性研究来开发更准确有效的风险模型，并评估在高危患者中针对模型使用CSF的疗效和成本效益。
