预防性使用培非格司亭在接受强化化疗的初诊急性淋巴细胞白血病患者中的临床效果。

Clinical effect of prophylactic pegfilgrastim in patients with newly diagnosed acute lymphoblastic leukemia who receive intensive chemotherapy.

机构信息

Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

Department of Laboratory Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

出版信息

Support Care Cancer. 2024 Oct 8;32(11):715. doi: 10.1007/s00520-024-08926-0.

DOI:10.1007/s00520-024-08926-0

PMID:39377915

Abstract

BACKGROUND

Using granulocyte colony-stimulating factor (G-CSF) after completing chemotherapy reduces the duration of neutropenia and infections. However, the efficacy and safety of prophylactic pegfilgrastim in acute lymphoblastic leukemia (ALL) patients have not yet been evaluated after intensive cytotoxic chemotherapy compared to the daily G-CSF. This study aimed to evaluate the efficacy of pegfilgrastim for ALL patients who received intensive chemotherapy compared with a short-acting G-CSF.

PATIENTS AND METHODS

Clinical data of 145 patients treated with hyper-CVAD, modified VPDL/VPD, or KALLA 1406/1407 regimen were retrospectively evaluated. Pegfilgrastim or the short-acting G-CSF was selected according to the clinician's discretion. Patients not receiving pegfilgrastim were treated with the short-acting G-CSF.

RESULTS

The median age of enrolled patients was 45 years. Sixty newly diagnosed ALL patients were treated with hyper-CVAD regimen, while KALLA and VPDL regimens were administered to 39 and 46 patients, respectively. Among the 60 patients treated with hyper-CVAD, 20 patients received pegfilgrastim. Patients who received pegfilgrastim had a significantly shorter duration of neutropenia and hospitalization and reduced incidence of severe infections compared to patients receiving the short-acting G-CSF. Consistent results were also confirmed in an analysis targeting only patients who achieved remission during hyper-CVAD induction therapy. There was no significant difference in neutrophil recovery ability and hospitalization duration when the daily short-acting G-CSF was used prophylactically after completing hyper-CVAD, KALLA, and VPDL regimens as induction therapy.

CONCLUSION

Using pegfilgrastim after hyper-CVAD therapy was more effective than the short-acting G-CSF in terms of infection, neutropenia recovery, and hospitalization in patients with newly diagnosed ALL.

摘要

背景

化疗后使用粒细胞集落刺激因子（G-CSF）可缩短中性粒细胞减少症和感染的持续时间。然而，与每日 G-CSF 相比，在强化细胞毒化疗后，预防性培非格司亭在急性淋巴细胞白血病（ALL）患者中的疗效和安全性尚未得到评估。本研究旨在评估培非格司亭在接受强化化疗的 ALL 患者中的疗效，与短效 G-CSF 相比。

患者和方法

回顾性评估了 145 例接受高剂量环磷酰胺、改良 VPDL/VPD、或 KALLA 1406/1407 方案治疗的患者的临床数据。培非格司亭或短效 G-CSF 根据临床医生的判断选择。未接受培非格司亭治疗的患者接受短效 G-CSF 治疗。

结果

纳入患者的中位年龄为 45 岁。60 例新诊断的 ALL 患者接受了高剂量环磷酰胺方案治疗，而 KALLA 和 VPDL 方案分别用于 39 例和 46 例患者。在接受高剂量环磷酰胺治疗的 60 例患者中，有 20 例患者接受了培非格司亭治疗。与接受短效 G-CSF 的患者相比，接受培非格司亭的患者中性粒细胞减少症和住院时间明显缩短，严重感染发生率降低。在仅针对接受高剂量环磷酰胺诱导治疗期间缓解的患者进行的分析中也证实了一致的结果。在完成高剂量环磷酰胺、KALLA 和 VPDL 方案作为诱导治疗后，每日预防性使用短效 G-CSF 时，中性粒细胞恢复能力和住院时间无显著差异。