Heuser Michael, Ganser Arnold, Bokemeyer Carsten
Department of Hematology, Hemostaseology, and Oncology, Hannover Medical School, Hannover, Germany.
Semin Hematol. 2007 Jul;44(3):148-56. doi: 10.1053/j.seminhematol.2007.04.002.
Chemotherapy-associated neutropenia is often dose-limiting and may compromise treatment efficacy. Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage-colony-stimulating factor (GM-CSF) are increasingly used to prevent febrile neutropenia (FN) or to increase dose-density. This review discusses recent changes in treatment guidelines for chemotherapy-associated neutropenia. Primary prophylactic use of CSFs is now recommended as a treatment option at an overall risk of FN of 20%, not taking into account cost-effectiveness. To estimate the risk of FN, patient-, disease-, and treatment-related factors predicting an adverse outcome of FN have been determined. Dose-dense chemotherapy has become feasible with the use of CSFs. However, clinical benefit has been shown only for specific chemotherapy regimens in breast cancer, small cell lung cancer (SCLC), and non-Hodgkin's lymphoma (NHL), for the latter particularly for patients above 60 years of age. Strategies are being developed to tailor the use of CSFs to patients with a high risk of adverse outcome of FN.
化疗相关中性粒细胞减少症常常限制剂量，且可能影响治疗效果。粒细胞集落刺激因子（G-CSF）和粒细胞巨噬细胞集落刺激因子（GM-CSF）越来越多地用于预防发热性中性粒细胞减少症（FN）或提高剂量密度。本综述讨论了化疗相关中性粒细胞减少症治疗指南的近期变化。目前推荐在FN总体风险为20%时将CSF的一级预防性使用作为一种治疗选择，而不考虑成本效益。为了评估FN的风险，已确定了预测FN不良结局的患者、疾病和治疗相关因素。使用CSF后剂量密集化疗已变得可行。然而，仅在乳腺癌、小细胞肺癌（SCLC）和非霍奇金淋巴瘤（NHL）的特定化疗方案中显示出临床获益，对于后者尤其在60岁以上患者中。正在制定策略，以便根据FN不良结局高风险患者的情况来调整CSF的使用。
