Oncology Department - Section D, Katowice Oncology Center, Raciborska 27, 40-074, Katowice, Poland.
Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Reymonta 8, 40-029, Katowice, Poland.
Support Care Cancer. 2023 Sep 1;31(9):549. doi: 10.1007/s00520-023-08015-8.
Neutropenia, defined as a number of neutrophils in patients' blood specimen lower than 1500 cells/μm, is a common adverse event during myelosuppressive oncological chemotherapy, predisposing to febrile neutropenia (FN). Patients with coexisting moderate-to-severe chronic kidney disease (CKD) have an increased risk of FN, included in the guidelines for the primary prophylaxis of FN. However, this does not include mild kidney function impairment with estimated glomerular filtration rate (eGFR) 60-89 ml/min/1.73 m. This prospective study analyzed the risk of neutropenia in patients on chemotherapy without indication for the primary prophylaxis of FN.
The study enrolled 38 patients starting chemotherapy, including 26 (68.4%) patients aged 65 years or more. The median duration of follow-up was 76 days. The methodology of creatinine assessment enabled the use of the recommended CKD-EPI formula for identifying patients with a mild reduction of glomerular filtration.
Sixteen (42.1%) patients developed at least G2 neutropenia without episodes of FN. Only five (13.1%) patients had eGFR < 60 ml/min/1.73 m, while 15 (62.5%) eGFR < 90 ml/min/1.73 m. The relative risk of neutropenia in patients with impaired eGFR was over six times higher than in patients with eGFR > 90 ml/min/1.73 m (RR = 6.08; 95%CI:1.45-27.29; p < 0.01).
Our observation indicates that even a mild reduction in eGFR is a risk factor for the development of neutropenia and a potential risk factor for FN. Authors are advised to check the author instructions for the journal they are submitting to for word limits and if structural elements like subheadings, citations, or equations are permitted.
中性粒细胞减少症是指患者血液样本中的中性粒细胞数量低于 1500 个/μm，这是骨髓抑制性肿瘤化疗中的常见不良反应，易导致发热性中性粒细胞减少症（FN）。合并中重度慢性肾脏病（CKD）的患者发生 FN 的风险增加，这在 FN 的一级预防指南中有所规定。然而，该指南并不包括肾小球滤过率（eGFR）为 60-89 ml/min/1.73 m 的轻度肾功能损害。本前瞻性研究分析了无 FN 一级预防指征的化疗患者发生中性粒细胞减少症的风险。
该研究纳入了 38 名开始化疗的患者，其中 26 名（68.4%）年龄在 65 岁及以上。中位随访时间为 76 天。肌酐评估方法允许使用推荐的 CKD-EPI 公式来识别肾小球滤过率轻度降低的患者。
16 名（42.1%）患者发生至少 G2 级中性粒细胞减少症，但无 FN 发作。只有 5 名（13.1%）患者的 eGFR < 60 ml/min/1.73 m，而 15 名（62.5%）患者的 eGFR < 90 ml/min/1.73 m。eGFR 受损患者发生中性粒细胞减少症的相对风险是 eGFR > 90 ml/min/1.73 m 患者的 6 倍以上（RR = 6.08；95%CI：1.45-27.29；p < 0.01）。
我们的观察表明，即使 eGFR 轻度降低也是发生中性粒细胞减少症的风险因素，也是 FN 的潜在风险因素。作者在向目标期刊投稿时，应查阅投稿说明，了解字数限制以及是否允许使用副标题、参考文献或方程式等结构性元素。
