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《中国化疗所致血小板减少症临床诊断、治疗及预防管理专家共识(2018年版)》

[Consensus on clinical diagnosis, treatment and prevention management of chemotherapy induced thrombocytopenia in China(2018)].

出版信息

Zhonghua Zhong Liu Za Zhi. 2018 Sep 23;40(9):714-720. doi: 10.3760/cma.j.issn.0253-3766.2018.09.014.

Abstract

Chemotherapy induced thrombocytopenia (CIT) is a common side-effect of chemotherapy in cancer patients, which lead to dose and cycle reduction or chemotherapy delay, or even the need of platelet transfusion. Therefore, CIT significantly increases the cost of treatment, reduces the efficacy of chemotherapy and the quality of life, and shortens the survival time of patients. The main treatments of CIT include transfusion of platelets, recombinant human thrombopoietin (rhTPO), and recombinant human interleukin-11 (rhIL-11). RhIL-11 is the first approved thrombocytopoietic cytokine. Interleukin-11 has been shown to be effective in the treatment of thrombocytopenia. RhTPO is a recombinant full-length glycosylated thrombopoietin, which is a ligand for c-Mpl protein. Several observations indicated that administration of rhTPO before and after chemotherapy might be beneficial to patients, which enhances platelet recovery and reduces thrombocytopenia after moderately myelosuppressive regimens. In recent years, the application of rhTPO in CIT treatment has dramatically changed the management and treatment plan of CIT. The China Society of Clinical Oncology (CSCO) published a consensus on CIT in 2014. Based on this, the expert committee updated "Consensus on clinical diagnosis, treatment and prevention management of chemotherapy induced thrombocytopenia in China (2018)" according to the recent literature and clinical research. The new evidence-based practice consensus for CIT aims to provide more reasonable diagnosis, treatment of prevention regimens for CIT patients to maintain the normal platelet counts.

摘要

化疗诱导的血小板减少症(CIT)是癌症患者化疗常见的副作用,可导致化疗剂量降低、周期缩短或化疗延迟,甚至需要输注血小板。因此,CIT显著增加了治疗成本,降低了化疗疗效和生活质量,并缩短了患者的生存时间。CIT的主要治疗方法包括输注血小板、重组人血小板生成素(rhTPO)和重组人白细胞介素-11(rhIL-11)。RhIL-11是首个获批的血小板生成细胞因子。白细胞介素-11已被证明对治疗血小板减少症有效。RhTPO是一种重组全长糖基化血小板生成素,是c-Mpl蛋白的配体。多项观察表明,化疗前后给予rhTPO可能对患者有益,可促进血小板恢复并减少中度骨髓抑制方案后的血小板减少症。近年来,rhTPO在CIT治疗中的应用极大地改变了CIT的管理和治疗方案。中国临床肿瘤学会(CSCO)于2014年发布了关于CIT的共识。在此基础上,专家委员会根据最新文献和临床研究更新了《中国化疗诱导血小板减少症的临床诊断、治疗及预防管理共识(2018年版)》。新的CIT循证实践共识旨在为CIT患者提供更合理的诊断、治疗及预防方案,以维持血小板计数正常。

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