Juliusson G, Lenkei R, Tjønnfjord G, Heldal D, Liliemark J
Department of Medicine, Huddinge Hospital, Sweden.
Ann Oncol. 1995 Apr;6(4):371-5. doi: 10.1093/oxfordjournals.annonc.a059186.
Neutropenic fever is the commonest complication of cladribine therapy for hairy-cell leukemia (HCL), leading to a 3% mortality rate. Our aim was to identify predictive factors and evaluate the effects of concomitant granulocyte-macrophage colony-stimulating factor (GM-CSF).
We studied 102 patients with active HCL given cladribine for 7 days. Pretreatment parameters predicting neutropenic fever were analysed. Twelve patients at high risk for febrile complications also received 400 micrograms GM-CSF per day on days 1 through 21.
Pretreatment anemia, hypocholesterolemia, bone marrow differential with a high percentage of hairy cells and a low percentage of myelopoietic cells, low albumin, and high C-reactive protein predicted neutropenic fever. The addition of GM-CSF did not improve the kinetics of recovery for neutrophils, hemoglobin or platelets, as compared to matched control patients. However, GM-CSF significantly reduced cladribine-induced lymphopenia, but not the incidence of neutropenic fever.
Factors predicting febrile neutropenia were identified. GM-CSF protected from cladribine lymphotoxicity but did not improve neutropenia or febrile episodes.
中性粒细胞减少性发热是克拉屈滨治疗毛细胞白血病（HCL）最常见的并发症，死亡率达3%。我们的目的是确定预测因素并评估同时使用粒细胞-巨噬细胞集落刺激因子（GM-CSF）的效果。
我们研究了102例接受克拉屈滨治疗7天的活动性HCL患者。分析了预测中性粒细胞减少性发热的预处理参数。12例有发热并发症高风险的患者在第1天至第21天还每天接受400微克GM-CSF治疗。
预处理时的贫血、低胆固醇血症、骨髓分类中毛细胞比例高而骨髓造血细胞比例低、低白蛋白以及高C反应蛋白可预测中性粒细胞减少性发热。与配对的对照患者相比，添加GM-CSF并未改善中性粒细胞、血红蛋白或血小板的恢复动力学。然而，GM-CSF显著减轻了克拉屈滨诱导的淋巴细胞减少，但未降低中性粒细胞减少性发热的发生率。
确定了预测发热性中性粒细胞减少的因素。GM-CSF可预防克拉屈滨的淋巴细胞毒性，但未改善中性粒细胞减少或发热发作情况。
