Romano Thiago Gomes, Chaves Rodrigo, Alves Izabela Sinara, Palomba Henrique
General ICU, Vila Nova Star Hospital/Oncological and Neurological ICU, São Luiz Itaim Hospital/General ICU, São Luiz Alphaville Hospital/Discipline of Nephrology, ABC School of Medicine/Rede D'or Research and Teaching Institute, São Paulo, Brazil.
Discipline of Nephrology, ABC School of Medicine, São Paulo, Brazil.
Front Nephrol. 2025 May 22;5:1597253. doi: 10.3389/fneph.2025.1597253. eCollection 2025.
A 67-year-old male patient with limited-stage diffuse large B-cell lymphoma was on an R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy regimen. His Eastern Cooperative Oncology Group (ECOG) Performance Scale score was zero, indicating functional independence for activities of daily living. The patient was admitted to the intensive care unit (ICU) with septic shock in the presence of febrile neutropenia progressing to acute kidney injury, hypoxemic respiratory failure, and systemic arterial hypotension, in addition to the already established hematological dysfunction with thrombocytopenia. During his 32-day ICU stay, he required invasive mechanical ventilation, renal replacement therapy (RRT) and vasopressor drugs, with a focus on control of the infection. The patient was discharged from the ICU with sarcopenia and a serum creatinine level of 2.3 mg/dL, indicating a clearance rate of 24 ml/min/1.73 m. Oxygen supplementation was needed. What impact did critical illness, more specifically renal dysfunction, have on the planning of onco-hematological treatment in this patient?
一名67岁的男性局限性弥漫性大B细胞淋巴瘤患者正在接受R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）化疗方案。他的东部肿瘤协作组（ECOG）体能状态评分为零，表明日常生活活动功能独立。该患者因发热性中性粒细胞减少进展为急性肾损伤、低氧性呼吸衰竭和系统性动脉低血压而并发感染性休克，被收入重症监护病房（ICU），此外还存在已确诊的伴有血小板减少的血液系统功能障碍。在他入住ICU的32天里，他需要有创机械通气、肾脏替代治疗（RRT）和血管活性药物，重点是控制感染。该患者出院时伴有肌肉减少症，血清肌酐水平为2.3mg/dL，肌酐清除率为24ml/min/1.73m²，仍需要吸氧。危重病，更具体地说是肾功能障碍，对该患者的肿瘤血液学治疗规划有何影响？
