The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA.
Expert Rev Clin Pharmacol. 2022 Aug;15(8):977-986. doi: 10.1080/17512433.2022.2110066. Epub 2022 Aug 8.
Febrile neutropenia (FN) is one of the complications of chemotherapy that can increase the risk of infection and mortality. Granulocyte colony-stimulating factors (G-CSFs) are used in practice to prevent and treat episodes of neutropenia. The use of G-CSFs in children with cancer has not been studied much for primary prophylaxis of FN.
Current data suggest that G-CSFs have a similar pharmacokinetic profile in children and adults. Clinical trials published from 2002 to 2021 using G-CSFs in pediatric cancer patients were reviewed. All evaluated clinical trials used a dosage of 5 mcg/kg of filgrastim daily until neutrophil recovery or a single dose of 100 mcg/kg pegfilgrastim. Filgrastim demonstrated the benefit in decreasing the duration of fever, hospital stay, and antibiotic use in high-risk neuroblastoma patients. Pegfilgrastim showed similar efficacy in reducing the occurrence of FN and infections, with bone pain as an adverse effect.
Filgrastim 5 mcg/kg/day or pegfilgrastim 100 mcg/kg single dose is appropriate when given at least 24 hours or after the chemotherapy in pediatric patients who weigh 45 kg or more. More prospective randomized trials are necessary to further investigate the efficacy and safety of G-CSFs in children with different types of cancer.
发热性中性粒细胞减少症（FN）是化疗的并发症之一，会增加感染和死亡的风险。粒细胞集落刺激因子（G-CSFs）在临床上用于预防和治疗中性粒细胞减少症。G-CSF 用于癌症儿童的 FN 一级预防的研究并不多。
目前的数据表明，G-CSF 在儿童和成人中的药代动力学特征相似。对 2002 年至 2021 年期间发表的在儿科癌症患者中使用 G-CSF 的临床试验进行了回顾。所有评估的临床试验均使用 5 mcg/kg 的非格司亭每日一次，直至中性粒细胞恢复，或使用 100 mcg/kg 的培非格司亭单次剂量。非格司亭在降低高危神经母细胞瘤患者发热持续时间、住院时间和抗生素使用方面显示出获益。培非格司亭在降低 FN 和感染的发生率方面具有相似的疗效，但会引起骨痛等不良反应。
对于体重 45kg 或以上的儿科患者，至少在化疗后 24 小时或之后给予 5 mcg/kg/天的非格司亭或 100 mcg/kg 的培非格司亭单次剂量是合适的。需要更多前瞻性随机试验来进一步研究 G-CSF 在不同类型癌症儿童中的疗效和安全性。
