Zelenetz Andrew D
Hematologic Oncology Laboratory, Memorial Sloan-Kettering, Cancer Center, New York, New York, USA.
Oncology (Williston Park). 2003 Nov;17(11 Suppl 11):21-6.
Non-Hodgkin's lymphoma is primarily a disease of the elderly, with 61% of the new cases reported in patients 60 years old or older. Aggressive combination chemotherapy can cure some patients, but there are frequently treatment failures and overall survival is low. Retrospective studies have found that treatment with less than standard chemotherapy doses is associated with lower survival, and surveys of practice patterns have found that many patients, especially elderly ones, are treated with substandard regimens and doses. Neutropenia is the major dose-limiting toxicity of chemotherapy in patients with non-Hodgkin's lymphoma. First-cycle use of colony-stimulating factor (CSF) can reduce the incidence of neutropenia and its complications and help maintain the chemotherapy doses. Researchers have investigated risk factors in patients with non-Hodgkin's lymphoma to determine which patients are at highest risk for neutropenia and would benefit from targeted first-cycle CSF support. It has been shown in several studies that advanced age, poor performance status, and high chemotherapy dose intensity are risk factors. Other trials suggest that low serum albumin levels, elevated lactate dehydrogenase levels, bone marrow involvement, and high levels of soluble tumor necrosis factor receptor are also risk factors. Dose intensity has also been shown in many studies to be an important predictor of survival in patients with non-Hodgkin's lymphoma. Managing the toxicity of chemotherapy with CSF has facilitated the delivery of planned dose on time, as well as dose-intensified chemotherapy regimens. The promising results from recent clinical trials of dose-dense regimens with CSF support suggest that this could prove to be the best strategy for improving patient outcomes.
非霍奇金淋巴瘤主要是一种老年疾病，60岁及以上患者报告的新病例占61%。积极的联合化疗可以治愈一些患者，但经常会出现治疗失败，总体生存率较低。回顾性研究发现，使用低于标准化疗剂量的治疗与较低的生存率相关，而对治疗模式的调查发现，许多患者，尤其是老年患者，接受的是不标准的治疗方案和剂量。中性粒细胞减少是化疗治疗非霍奇金淋巴瘤患者时的主要剂量限制性毒性。在化疗第一周期使用集落刺激因子（CSF）可以降低中性粒细胞减少及其并发症的发生率，并有助于维持化疗剂量。研究人员对非霍奇金淋巴瘤患者的危险因素进行了调查，以确定哪些患者发生中性粒细胞减少的风险最高，以及哪些患者将从有针对性的第一周期CSF支持中获益。多项研究表明，高龄、身体状况差和化疗剂量强度高是危险因素。其他试验表明，低血清白蛋白水平、乳酸脱氢酶水平升高、骨髓受累以及可溶性肿瘤坏死因子受体水平高也是危险因素。许多研究还表明，剂量强度是非霍奇金淋巴瘤患者生存的重要预测因素。使用CSF管理化疗毒性有助于按时给予计划剂量以及强化剂量的化疗方案。近期有CSF支持的剂量密集方案临床试验取得的有前景的结果表明，这可能被证明是改善患者预后的最佳策略。
