Department of Oncology, Saarland University Medical School, Homburg, Germany.
Ann Oncol. 2011 Aug;22(8):1872-7. doi: 10.1093/annonc/mdq674. Epub 2011 Feb 3.
To study the effects of deferring pegfilgrastim until day 4 on the reduction of chemotherapy-induced leukocytopenia.
Patients of age 61-80 years with aggressive lymphoma were randomly assigned to receive 6 mg pegfilgrastim on day 2 or 4 of a 2-week chemotherapy regimen (R-CHOP-14).
Two hundred and ninety-two and 313 chemotherapy cycles were evaluable in 103 patients. Post-nadir pegfilgrastim serum levels were higher after day 4 than after day 2 application. This was associated with an attenuated leukocyte nadir after day 4 pegfilgrastim and there were fewer days with leukocytes <2 × 10(3)/mm(3) compared with day 2 pegfilgrastim. Grade 3 and 4 leukocytopenias (70% versus 43.3%; P < 0.001) and grade 4-only leukocytopenias (47% versus 20.5%; P < 0.001) were more frequent after day 2 pegfilgrastim. There were more chemotherapy cycles with grade 3 and 4 infections after day 2 than day 4 pegfilgrastim (9.4% versus 6.0%; P = 0.118). Interventional antibiotics were given more often after day 2 than after day 4 pegfilgrastim (30.7% versus 21.9% of cycles; P = 0.008). There were five deaths during leukocytopenia after day 2 and none after day 4 pegfilgrastim (P = 0.027).
Administration of pegfilgrastim on day 4 was more effective in reducing severe leukocytopenias and resulted in fewer deaths during leukocytopenia. Pegfilgrastim should be given on day 4 to better exploit its myeloprotective potential.
研究延迟培非格司亭至第 4 天对减少化疗引起的白细胞减少症的影响。
年龄在 61-80 岁之间的侵袭性淋巴瘤患者被随机分配接受 6mg 培非格司亭在两周化疗方案（R-CHOP-14）的第 2 天或第 4 天。
103 例患者中有 292 和 313 个化疗周期可评估。第 4 天培非格司亭后血清水平较第 2 天更高。这与第 4 天培非格司亭后白细胞减少的峰值较低有关，并且与第 2 天培非格司亭相比，白细胞<2×10(3)/mm(3)的天数更少。第 2 天培非格司亭组（70%比 43.3%；P<0.001）和第 4 天培非格司亭组（47%比 20.5%；P<0.001）更常见 3 级和 4 级白细胞减少症，仅 4 级白细胞减少症更常见。第 2 天培非格司亭组比第 4 天培非格司亭组更频繁地发生 3 级和 4 级感染的化疗周期（9.4%比 6.0%；P=0.118）。第 2 天培非格司亭组比第 4 天培非格司亭组更常使用介入性抗生素（30.7%比 21.9%的周期；P=0.008）。第 2 天培非格司亭后白细胞减少症期间有 5 例死亡，第 4 天培非格司亭后无死亡（P=0.027）。
第 4 天给予培非格司亭更有效降低严重白细胞减少症，并且在白细胞减少症期间导致更少的死亡。培非格司亭应在第 4 天给予，以更好地利用其骨髓保护潜力。
