Lokich Jacob J
The Cancer Center of Boston, Chestnut Hill, MA, USA.
Am J Clin Oncol. 2006 Aug;29(4):361-3. doi: 10.1097/01.coc.0000217816.16236.22.
To determine if "same day" Pegfilgrastim (Pf) with CHOP chemotherapy for non-Hodgkin lymphoma impacts on nadir white blood count (WBC) levels or on the nadir day.
Ten patients with non-Hodgkin lymphoma treated with CHOP-R; CHOP with liposomal Doxorubicin replacing H; or CVAD received 'same day' Pf in a minimum of one cycle of chemotherapy to a maximum of 6 cycles with 8 of 10 patients receiving same day Pf for some but not all cycles allowing for comparison of nadir WBC levels within patients.
A total of 43 cycles of chemotherapy were reviewed. Same day Pf was administered with 21 of 43 cycles in all 10 patients with 8 of 10 receiving 22 cycles without Pf as well. White blood count nadir level and nadir day were compared in 9 patients in whom same day Pf was or was not administered in selected cycles. One patient experienced febrile neutropenia in a single cycle. Median nadir count and nadir day for cycles delivered with same day Pf was 1500 cells/ml (range, 200-11,000) at 14 days (range, 7-14 days). Median nadir count and nadir day cycles not delivered with same day Pf was 1600 cells/m and day 14 (range, 7-14), respectively. Four of 21 cycles (19%) delivered with same day Pf were associated with grade 4 leukopenia compared with 2 of 23 cycles (9%) delivered without same day Pf. With regard to the total 10 patient population 4 patients had a grade 4 leukopenia experience with same day Pf and 2 patients had a grade 4 leukopenia experience without same day Pf. Grade 4 leukopenia had a median nadir day of 7.
Same day Pf may accentuate neutropenia in some patients with non-Hodgkin lymphoma receiving standard CHOP or CHOP-R chemotherapy but expanded studies are necessary to establish this point definitively. The accentuated neutropenia may be related to the specific chemotherapy regimen or drug, eg, cyclophosphamate since same day Pf was safe with regimens in which a non alkylating agent (taxane, gemcitabine, navelbine, cisplatin) was used with a weekly chemotherapy dosing schema and did not generate accentuated neutropenia.
确定非霍奇金淋巴瘤患者在接受CHOP化疗时同一天使用培非格司亭（Pf）是否会影响白细胞计数最低点（WBC）水平或最低点出现的时间。
10例接受CHOP-R治疗的非霍奇金淋巴瘤患者；用脂质体阿霉素替代H的CHOP方案；或接受CVAD方案治疗的患者，在至少一个化疗周期至最多6个化疗周期中接受同一天的Pf治疗，10例患者中有8例在部分而非全部周期中接受同一天的Pf治疗，以便比较患者体内白细胞计数最低点水平。
共回顾了43个化疗周期。所有10例患者在43个周期中的21个周期中接受了同一天的Pf治疗，10例患者中有8例在22个未使用Pf的周期中也接受了治疗。对9例在选定周期中接受或未接受同一天Pf治疗的患者的白细胞计数最低点水平和最低点出现时间进行了比较。1例患者在单个周期中出现发热性中性粒细胞减少。同一天使用Pf的周期的中位最低点计数和最低点出现时间分别为14天（范围7-14天）时的1500个细胞/毫升（范围200-11,000）。未同一天使用Pf的周期的中位最低点计数和最低点出现时间分别为1600个细胞/毫升和第14天（范围7-14天）。同一天使用Pf的21个周期中有4个（19%）与4级白细胞减少相关，而未同一天使用Pf的23个周期中有2个（9%）与4级白细胞减少相关。就全部10例患者而言，4例患者在同一天使用Pf时有4级白细胞减少经历，2例患者在未同一天使用Pf时有4级白细胞减少经历。4级白细胞减少的中位最低点出现时间为7天。
同一天使用Pf可能会使一些接受标准CHOP或CHOP-R化疗的非霍奇金淋巴瘤患者的中性粒细胞减少加重，但需要进一步扩大研究以明确这一点。中性粒细胞减少加重可能与特定的化疗方案或药物有关，例如环磷酰胺，因为同一天使用Pf在使用非烷化剂（紫杉烷、吉西他滨、长春瑞滨、顺铂）并采用每周化疗给药方案的方案中是安全的，且不会导致中性粒细胞减少加重。
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