Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia.
Eur J Haematol. 2012 May;88(5):416-21. doi: 10.1111/j.1600-0609.2012.01763.x. Epub 2012 Feb 27.
Granulocyte Colony-Stimulating Factor (G-CSF) is commonly used to maintain dose intensity in patients receiving ABVD chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine) for Hodgkin lymphoma. However, the need for growth factor support is unclear, with studies suggesting that dose intensity can be maintained without G-CSF. Moreover, G-CSF is expensive (pegfilgrastim: EUR 1540/cycle; 300 μg filgrastim for 7 days: EUR 700/cycle) and is associated with side effects including bone pain and increased risk of bleomycin lung toxicity. Intermittent G-CSF may be an effective compromise, given that the effect of G-CSF on granulocyte precursors in vitro persists for 4-5 days after administration. After promising results of a pilot study, this schedule has been used subsequently in the majority of our patients receiving G-CSF as secondary prophylaxis for ABVD complicated by neutropenia.
Retrospective analysis of the incidence of febrile neutropenia and treatment delay in a variety of different G-CSF schedules used as secondary prophylaxis in patients receiving ABVD.
848 cycles in 85 consecutive patients were evaluated. Most patients (86%) received G-CSF, generally commenced prophylactically for neutropenia when cycle 1B was due. Intermittent G-CSF (typically given on days 4, 8 and 12) was used in 413 cycles compared with daily or pegylated G-CSF in 99 cycles. In patients receiving intermittent G-CSF, the median neutrophil count, across all cycles, was 7.3 × 10(9) /L (range: 1.4-47.1) when the next scheduled chemotherapy was due. There were two cases of febrile neutropenia (0.45%) and no treatment delays. One patient developed possible bleomycin toxicity.
Intermittent G-CSF is effective in maintaining dose intensity in patients receiving ABVD.
粒细胞集落刺激因子（G-CSF）常用于维持接受 ABVD 化疗（阿霉素、博来霉素、长春碱和达卡巴嗪）的霍奇金淋巴瘤患者的剂量强度。然而，是否需要生长因子支持尚不清楚，一些研究表明可以在不使用 G-CSF 的情况下维持剂量强度。此外，G-CSF 价格昂贵（培非格司亭：1540 欧元/周期；300μg 非格司亭连用 7 天：700 欧元/周期），且与副作用相关，包括骨痛和博来霉素肺毒性风险增加。间歇性 G-CSF 可能是一种有效的折衷方案，因为 G-CSF 对体外粒细胞前体的作用在给药后 4-5 天内持续存在。在一项初步研究取得良好结果后，该方案随后在我们大多数接受 G-CSF 作为 ABVD 合并中性粒细胞减少症二级预防的患者中使用。
回顾性分析不同 G-CSF 方案作为 ABVD 二级预防在接受 ABVD 治疗的患者中的应用中发热性中性粒细胞减少症的发生率和治疗延迟情况。
共评估了 85 例连续患者的 848 个周期。大多数患者（86%）接受 G-CSF 治疗，通常在第 1B 周期开始时预防性用于中性粒细胞减少症。与 99 个周期使用每日或聚乙二醇化 G-CSF 相比，413 个周期使用间歇性 G-CSF（通常在第 4、8 和 12 天使用）。接受间歇性 G-CSF 的患者，在所有周期中，当下一次计划化疗开始时，中位数中性粒细胞计数为 7.3×10(9)/L（范围：1.4-47.1）。有 2 例发热性中性粒细胞减少症（0.45%）和无治疗延迟。1 例患者出现可能的博来霉素毒性。
间歇性 G-CSF 可有效维持接受 ABVD 治疗的患者的剂量强度。
