Département d'Oncologie Pédiatrique, Hôpital pour Enfants de La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.
Clin Ther. 2009;31 Pt 2:2388-95. doi: 10.1016/j.clinthera.2009.11.013.
Filgrastim is an effective granulocyte colony-stimulating factor (G-CSF) used to reduce periods of neutropenia and the risk of infection after chemotherapy courses. Pegfilgrastim is a pegylated filgrastim with a longer plasma half-life that is administered once per cycle.
The aim of this study was to compare the efficacy of pegfilgrastim and filgrastim administered after chemotherapy in children with Ewing sarcoma.
We performed a retrospective chart review of pediatric patients with Ewing sarcoma. Every patient received both types of G-CSF in different treatment courses of chemotherapy, which consisted of vincristine, ifosfamide, doxorubicin, and etoposide (VIDE); vincristine, actinomycin D, and ifosfamide (VAI); or vincristine, actinomycin D, and cyclophosphamide (VAC). A single injection of pegfilgrastim 100 microg/kg SC or a daily injection of filgrastim 5 to 10 microg/kg SC was administered 48 to 72 hours after the completion of chemotherapy. The following data were collected from the medical charts: proportion of chemotherapy courses with grade 4 neutropenia, duration of grade 4 neutropenia, proportion with severe neutropenia, duration of severe neutropenia, proportion with febrile neutropenia, duration of antibiotic treatment, duration of hospitalization, and percentage of patients receiving transfusion. Grade 4 neutropenia was defined as an absolute neutrophil count of <500 x 10(9)/L; severe neutropenia was defined as a count of <200 x 10(9)/L. Adverse events were collected from the medical charts.
Twenty children were included (13 girls and 7 boys). The patients' median age was 12.8 years (range, 9-17 years) and median weight was 45.2 kg (range, 28-90 kg). A total of 178 chemotherapy courses (108 VIDE; 70 VAI or VAC) were administered and evaluated, including 134 courses with pegfilgrastim and 44 courses with filgrastim. Considering all types of chemotherapy combined, those courses in which pegfilgrastim was used were associated with a significantly lower incidence of severe neutropenia (0.21 vs 0.85; P = 0.03), a shorter duration of severe neutropenia (0.49 vs 2.36 days; P = 0.01), and a shorter duration of antibiotic treatment (1.07 vs 4.22 days; P = 0.03) compared with courses treated with filgrastim. No statistically significant differences were observed for the proportion and duration of grade 4 neutropenia, proportion of febrile neutropenia, duration of hospitalization, or red blood cell and platelet transfusions. Adverse effects were few and comparable between pegfilgrastim and filgrastim.
In this retrospective chart review of children with Ewing sarcoma, using pegfilgrastim after chemotherapy courses was associated with significantly reduced frequency and shorter duration of severe neutropenia compared with those courses followed by filgrastim. Randomized controlled trials are needed to confirm these preliminary observations.
非格司亭是一种有效的粒细胞集落刺激因子（G-CSF），用于减少化疗后中性粒细胞减少症的持续时间和感染风险。培非格司亭是一种聚乙二醇化的非格司亭，具有更长的血浆半衰期，每周期给药一次。
本研究旨在比较培非格司亭和非格司亭在尤文肉瘤患儿化疗后的疗效。
我们对尤文肉瘤患儿进行了回顾性图表审查。每位患者在不同的化疗疗程中都接受了两种类型的 G-CSF，这些疗程包括长春新碱、异环磷酰胺、多柔比星和依托泊苷（VIDE）；长春新碱、放线菌素 D 和异环磷酰胺（VAI）；或长春新碱、放线菌素 D 和环磷酰胺（VAC）。在化疗完成后 48 至 72 小时，给予培非格司亭 100μg/kg SC 或每日注射非格司亭 5 至 10μg/kg SC。从病历中收集了以下数据：发生 4 级中性粒细胞减少症的化疗疗程比例、4 级中性粒细胞减少症的持续时间、严重中性粒细胞减少症的比例、严重中性粒细胞减少症的持续时间、发热性中性粒细胞减少症的比例、抗生素治疗的持续时间、住院时间和接受输血的患者比例。4 级中性粒细胞减少症定义为绝对中性粒细胞计数<500×109/L；严重中性粒细胞减少症定义为计数<200×109/L。从病历中收集了不良事件。
共纳入 20 名儿童（13 名女孩和 7 名男孩）。患者的中位年龄为 12.8 岁（范围，9-17 岁），中位体重为 45.2kg（范围，28-90kg）。共进行了 178 个化疗疗程（108 个 VIDE；70 个 VAI 或 VAC），并对其中 134 个疗程进行了培非格司亭治疗，44 个疗程进行了非格司亭治疗。考虑到所有类型的化疗联合使用，与使用非格司亭治疗的疗程相比，使用培非格司亭的疗程中严重中性粒细胞减少症的发生率显著降低（0.21 比 0.85；P=0.03），严重中性粒细胞减少症的持续时间更短（0.49 比 2.36 天；P=0.01），抗生素治疗的持续时间更短（1.07 比 4.22 天；P=0.03）。但在 4 级中性粒细胞减少症的发生率和持续时间、发热性中性粒细胞减少症的比例、住院时间或红细胞和血小板输血方面，两组之间无统计学差异。不良反应较少，培非格司亭与非格司亭之间相当。
在这项对尤文肉瘤患儿的回顾性图表审查中，与非格司亭相比，培非格司亭在化疗后可显著降低严重中性粒细胞减少症的发生频率和持续时间。需要进行随机对照试验来证实这些初步观察结果。
