Badr Mohamed, Hassan Tamer, Sakr Hanan, Karam Nehad, Rahman Doaa Abdel, Shahbah Doaa, Zakaria Marwa, Fehr Sahbaa
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Sharqia 44111, Egypt.
Mol Clin Oncol. 2016 Sep;5(3):300-306. doi: 10.3892/mco.2016.957. Epub 2016 Jul 12.
Chemotherapy-induced neutropenia (CIN) is the major dose-limiting toxicity of systemic chemotherapy and it is associated with significant morbidity, mortality and treatment cost. The aim of the present study was to identify the risk factors that may predispose pediatric cancer patients who receive myelosuppressive chemotherapy to CIN and associated sequelae. A total of 113 neutropenia episodes were analyzed and the risk factors for CIN were classified as patient-specific, disease-specific and regimen-specific, while the consequences of CIN were divided into infectious and dose-modifying sequelae. The risks and consequences were analyzed to target high-risk patients with appropriate preventive strategies. Among our patients, 28% presented with a single neutropenia attack, while 72% experienced recurrent attacks during their treatment cycles. The mean absolute neutrophil count was 225.5±128.5 ×10/l (range, 10-497 ×10/l), starting 14.2±16.3 days (range, 2-100 days) after the onset of chemotherapy and resolving within 11.2±7.3 days, either with (45.1%) or without (54.9%) granulocyte colony-stimulating factor (G-CSF). No significant association was observed between any patient characteristics or disease stage and the risk for CIN. However, certain malignancies, such as acute lymphocytic leukemia (ALL), neuroblastoma and Burkitt's lymphoma, and certain regimens, such as induction block for ALL and acute myelocytic leukemia, exerted the most potent myelotoxic effect, with severe and prolonged episodes of neutropenia. G-CSF significantly shortened the duration of the episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complication among our cases (73.5%) and was associated with several documented infections, particularly mucositis (54.9%), respiratory (45.1%), gastrointestinal tract (38.9%) and skin (23.9%) infections. A total of 6% of our patients succumbed to infection-related complications. Neutropenia was responsible for treatment discontinuation (13.3%), dose delay (13.3%) and dose reduction (5.3%) in our patients. The mean cost for each episode in our institution was 9,386.5±6,688.9 Egyptian pounds, which represented a significant burden on health care providers.
化疗引起的中性粒细胞减少症（CIN）是全身化疗的主要剂量限制性毒性反应，与显著的发病率、死亡率及治疗费用相关。本研究旨在确定可能使接受骨髓抑制性化疗的儿科癌症患者易发生CIN及其相关后遗症的危险因素。共分析了113例中性粒细胞减少症发作病例，将CIN的危险因素分为患者特异性、疾病特异性和方案特异性，而CIN的后果分为感染性和剂量调整性后遗症。分析这些风险和后果，以便针对高危患者采取适当的预防策略。在我们的患者中，28%出现单次中性粒细胞减少发作，而72%在治疗周期中经历复发发作。中性粒细胞绝对计数平均值为225.5±128.5×10⁹/L（范围为10 - 497×10⁹/L），在化疗开始后14.2±16.3天（范围为2 - 100天）开始出现，并在11.2±7.3天内缓解，使用（45.1%）或未使用（54.9%）粒细胞集落刺激因子（G-CSF）。未观察到任何患者特征或疾病分期与CIN风险之间存在显著关联。然而，某些恶性肿瘤，如急性淋巴细胞白血病（ALL）、神经母细胞瘤和伯基特淋巴瘤，以及某些方案，如ALL和急性髓细胞白血病的诱导阻滞方案，具有最强的骨髓毒性作用，会导致严重且持续时间长的中性粒细胞减少发作。G-CSF显著缩短了发作持续时间并促进了骨髓恢复。发热性中性粒细胞减少症是我们病例中的主要并发症（73.5%），与多种已记录的感染相关，尤其是口腔炎（54.9%）、呼吸道感染（45.1%）、胃肠道感染（38.9%）和皮肤感染（23.9%）。我们共有6%的患者死于感染相关并发症。中性粒细胞减少导致我们的患者治疗中断（13.3%）、剂量延迟（13.3%）和剂量减少（5.3%）。我们机构中每次发作的平均费用为9386.5±6688.9埃及镑，这对医疗服务提供者来说是一项沉重负担。
