中国肿瘤药物相关血小板减少诊疗专家共识(2023版)

Consensus on the clinical diagnosis,treatment and prevention of cancer treatment-induced thrombocytopenia in China (2023 edition)

肿瘤药物相关血小板减少(CTIT)为抗肿瘤药物治疗常见的不良反应,其发生率与肿瘤类型、治疗方案及治疗周期等有关。CTIT可导致出血、药物剂量强度降低及治疗时间延迟,严重时甚至需要输注血小板,最终影响治疗方案按计划实施、增加治疗费用、降低抗肿瘤疗效和生存质量,导致不良预后。CTIT的治疗应首先明确病因,评估出血风险,再根据病因及血小板减少的严重程度采取相应的治疗策略。主要治疗措施包括输注血小板、应用各类促血小板生成药物,以及减少血小板破坏的治疗。其中,促血小板生成的药物主要指促血小板生长因子,包括重组人血小板生成素(rhTPO)、重组人白细胞介素-11(rhIL-11)和血小板生成素受体激动剂(TPO-RAs)等。中医中药在提升血小板方面也有一定的辅助作用。此外,对高危患者进行Ⅱ级预防有助于降低CTIT的发生率和严重程度。本共识旨在为中国肿瘤科医生提供更合理的CTIT诊疗方案,降低患者因肿瘤治疗所致血小板减少相关出血风险,提高患者生存质量。

Cancer treatment-induced thrombocytopenia(CTIT)is a common adverse event during anti-tumor treatment,of which incidence is related to tumor classification,regimens,course of chemotherapy,etc.CTIT may result in a series of events including bleeding,dose intensity reduction,chemotherapy delay,and in severe cases,even the need for platelet transfusion,ultimately affecting the implementation of treatment plan,increasing the cost of treatment,reducing treatment effect and quality of life,and leading to a poor prognosis.The treatment of CTIT should first identify the cause,assess the risk of bleeding,and then adopt treatment strategies according to the cause and severity of CTIT.The main treatments of CTIT include platelet transfusion,application of various types of platelet-producing drugs,and measures to reduce the additional loss of platelets.Among them,platelet-producing drugs mainly refer to platelet-stimulating factors,including recombinant human thrombopoietin(rhTPO),recombinant human interleukin 11(rhIL-11),and thrombopoietin receptor agonists(TPO-RAs).In addition,traditional Chinese medicine also has some assistance in raising platelets.Pharmacological prophylaxis in high-risk patients may help reduce the incidence and severity of CTIT.This consensus aims to support Chinese oncologists in the diagnosis and treatment of CTIT in China,reduce the risk of bleeding and improve the quality of life of patients.