Waight Clinton C, Cain Rebecca
Pharmacy Department, Victoria Hospital Kirkcaldy, NHS Fife, UK
Pharmacy Department, Victoria Hospital Kirkcaldy, NHS Fife, UK.
J Oncol Pharm Pract. 2014 Oct;20(5):351-5. doi: 10.1177/1078155213508438. Epub 2013 Oct 23.
Bortezomib treatment requires four visits to a chemotherapy unit in each 21-day cycle. Analysis of the Day 1 full blood count could allow clinicians to predict the risk of Grade 4 thrombocytopenia, thus negating the need to review the full blood count prior to each dose. The freedom to administer bortezomib without reviewing full blood count results on each treatment day could minimise appointment times and be a step toward home administration. A prospective study of treatment authorisation following a full toxicity assessment and full blood count results from the previous treatment day was undertaken. The full blood count results from 27 patients, receiving 381 doses revealed 12 treatment episodes where bortezomib was administered in the presence of Grade 4 thrombocytopenia. One instance of bleeding and two episodes of neutropenic sepsis were detected during toxicity assessments and treatment was not administered. Only one instance of Grade 4 thrombocytopenia was reported on any other treatment day when the Day 1 platelet count was greater than 75 × 10(9) units/l. From this data, Day 1 full blood count parameters were derived, which minimise the risk of Grade 4 haematological toxicity on subsequent treatment days, allowing clinicians to identify suitable patients for administration of bortezomib prior to reviewing full blood count results. When platelet counts on Day 1 are greater than 75 × 10(9) units/l and neutrophil counts are greater than 1.0 × 10(9) units/l, the administration of bortezomib can be authorised without the need for review of the full blood count on subsequent days of that cycle.
硼替佐米治疗在每21天的周期中需要到化疗科就诊4次。分析第1天的全血细胞计数可使临床医生预测4级血小板减少症的风险，从而无需在每次给药前复查全血细胞计数。在每次治疗日无需复查全血细胞计数结果即可给予硼替佐米，这可以将预约时间减至最短，并朝着居家给药迈出一步。我们进行了一项前瞻性研究，该研究依据前一治疗日的全面毒性评估和全血细胞计数结果进行治疗授权。27例患者接受了381剂治疗，其全血细胞计数结果显示，有12个治疗疗程在存在4级血小板减少症的情况下给予了硼替佐米。在毒性评估期间检测到1例出血和2例中性粒细胞减少性脓毒症发作，未给予治疗。当第1天血小板计数大于75×10⁹单位/升时，在任何其他治疗日仅报告了1例4级血小板减少症。根据这些数据得出了第1天的全血细胞计数参数，这些参数可将后续治疗日发生4级血液学毒性的风险降至最低，使临床医生在复查全血细胞计数结果之前就能确定适合给予硼替佐米的患者。当第1天的血小板计数大于75×10⁹单位/升且中性粒细胞计数大于1.0×10⁹单位/升时，可授权给予硼替佐米，而无需在该周期的后续日子复查全血细胞计数。
