Lyman Gary H, Morrison Vicki A, Dale David C, Crawford Jeffrey, Delgado David J, Fridman Moshe
James P Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704 Rochester, NY 14642, USA.
Leuk Lymphoma. 2003 Dec;44(12):2069-76. doi: 10.1080/1042819031000119262.
We sought to identify risk factors associated with the time to febrile neutropenia in patients with intermediate-grade, non-Hodgkin's lymphoma (NHL) who were receiving treatment with CHOP chemotherapy. Data were collected from 12 community and academic oncology practices participating in the Oncology Practice Pattern Study between 1991 and 1999. We reviewed the medical records of 577 intermediate-grade NHL patients who received initial CHOP chemotherapy and evaluated risk factors associated with time to first febrile neutropenic event. A febrile neutropenic event was defined as a body temperature of > 100.6 degrees F and an ANC nadir < 1000/mm3. A total of 160 patients experienced 224 febrile neutropenic events. The risk of febrile neutropenia was significantly associated with age > or = 65 years (p = 0.001), cardiovascular disease (p = 0.020), renal disease (p = 0.006), baseline hemoglobin < 12 g/dl (p = 0.018), > 80% planned average relative dose intensity (ARDI; p = 0.018), and no prophylactic colony-stimulating factor (CSF) use (p = 0.046). First febrile neutropenic events occurred by day 14 of cycle 1 in one-half of patients experiencing febrile neutropenia. In multivariate analysis, the risk of febrile neutropenia remained significantly associated with age > or = 65 years (HR = 1.65, 95% CI: 1.18-2.32), renal disease (HR = 1.91. 95% CI: 1.10-3.30), cardiovascular disease (HR = 1.54, 95% CI: 1.02-2.33), baseline hemoglobin < 12 g/dl (HR = 1.44, 95% CI: 1.04-2.00), > 80% planned CHOP ARDI (HR = 2.41, 95% CI: 1.30-4.47), and no CSF prophylaxis (HR = 2.13, 95% CI: 1.20-3.76). Such a model may permit the identification of patients at greatest risk of febrile neutropenia and, therefore, candidates for the selective prophylactic use of the hematopoietic growth factors.
我们试图确定接受CHOP化疗的中级别非霍奇金淋巴瘤（NHL）患者发生发热性中性粒细胞减少症时间的相关危险因素。数据收集自1991年至1999年间参与肿瘤学实践模式研究的12家社区和学术肿瘤学机构。我们回顾了577例接受初始CHOP化疗的中级别NHL患者的病历，并评估了与首次发热性中性粒细胞减少事件发生时间相关的危险因素。发热性中性粒细胞减少事件定义为体温>100.6华氏度且中性粒细胞绝对计数最低点<1000/mm³。共有160例患者经历了224次发热性中性粒细胞减少事件。发热性中性粒细胞减少的风险与年龄≥65岁（p = 0.001）、心血管疾病（p = 0.020）、肾脏疾病（p = 0.006）、基线血红蛋白<12 g/dl（p = 0.018）、计划平均相对剂量强度（ARDI）>80%（p = 0.018）以及未使用预防性集落刺激因子（CSF）（p = 0.046）显著相关。在经历发热性中性粒细胞减少的患者中，一半患者在第1周期的第14天之前发生了首次发热性中性粒细胞减少事件。在多变量分析中，发热性中性粒细胞减少的风险仍与年龄≥65岁（HR = 1.65，95%CI：1.18 - 2.32）、肾脏疾病（HR = 1.91，95%CI：1.10 - 3.30）、心血管疾病（HR = 1.54，95%CI：1.02 - 2.33）、基线血红蛋白<12 g/dl（HR = 1.44，95%CI：1.04 - 2.00）、计划CHOP ARDI>80%（HR = 2.41，95%CI：1.30 - 4.47）以及未进行CSF预防（HR = 2.13，95%CI：1.20 - 3.76）显著相关。这样一个模型可能有助于识别发热性中性粒细胞减少风险最高的患者，从而确定造血生长因子选择性预防性使用的候选者。
