低剂量聚乙二醇化重组人粒细胞刺激因子预防肺癌化疗后中性粒细胞减少的有效性和安全性分析

Analysis of the efficacy and safety of low dose pegylated recombinant human granulocyte colony-stimulating factor treated with neutropenia after chemotherapy with lung cancer

目的本研究探讨低剂量聚乙二醇化重组人粒细胞刺激因子(pegylated recombinant human granulocyte colony stimulating,PEG-rhG-CSF)对于预防肺癌化疗导致的中性粒细胞减少症的有效性及安全性。方法2021年11月至2023年5月中国医学科学院肿瘤医院综合科收治的肺癌化疗患者40例作为一级预防组,在每周期化疗结束24h给予低剂量PEG-rhG-CSF 3mg进行预防性治疗;同时选择同期的肺癌化疗后前一周期出现中性粒细胞减少患者40例作为二级预防组,在第2个周期化疗后24h给予低剂量PEG-rhG-CSF 3mg进行预防性治疗,观察化疗后未发生中性粒细胞减少、发热及应用抗菌药物的比例及安全性评价。结果一级预防组患者治疗后31例(77.5%)未出现中性粒细胞减少,9例(22.5%)出现中性粒细胞减少,其中3~4级中性粒细胞减少2例(5.0%),1例合并抗生素治疗,1例因出现4级血小板减少导致化疗药物减量并化疗延迟。二级预防组治疗前1~2级中性粒细胞减少22例(55%),3~4级中性粒细胞减少18例(45%),1例出现中性粒细胞减少性发热(febrile neutropenia,FN)合并抗生素治疗,发生率2.5%,化疗延迟10例(25.0%)。在给予3mg PEG-rhG-CSF治疗后,32例(80.0%)未出现中性粒细胞减少,8例(20.0%)出现中性粒细胞减少,其中3~4级中性粒细胞减少者3例(7.5%),无化疗药物减量者,化疗延迟1例(2.5%),无发热及使用抗菌药物。两组不良反应主要为骨痛(15.0%比12.5%)及乏力(7.5%比10%)。结论低剂量聚乙二醇化粒细胞刺激因子能够预防肺癌化疗后中性粒细胞减少,且安全性良好。

Objective To evaluate the efficacy and safety of low dose pegylated recombinabt human granulocyte stimulating factor(PEGrhG-CSF)on the prevention of neutropenia caused by chemotherapy in patients with lung cancer.Method From November 2021 to May 2023,forty patients with lung cancer were enrolled in the Department of Comprehensive Oncology of Cancer Hospital,Chinese Academy of Medical Sciences as primary prevention group and were given low dose of PEG-rhG-CSF 3mg 24 hours after each cycle of chemotherapy.Forty patients with neutropenia after chemotherapy with lung cancer were enrolled as the secondary prevention group and low dose of PEG-rhG-CSF 3mg was given 24 hours after the next cycle of chemotherapy.To observe the proportion of patients with neutropenia,fever,antibiotic application and safety evaluation.Result In the primary prevention group,nine patients(22.5%)had neutropenia,of which two patients(5.0%)had grade 3 to 4 neutropenia.One patient was treated with antibiotics.Chemotherapy was delayed in one patient(2.5%).Chemotherapy dose was reduced in one patient with grade 4 thrombocytopenia.In the secondary prevention group,twenty-two patients(55%)had 1 to 2 grade neutropenia and eighteen(45%)had 3 to 4 grade neutropenia.One had febrile neutropenia(FN)combined with antibiotics,with an incidence of 2.5%.Chemotherapy was delayed in 10 patients(25.0%).After treatment of 3mg PEG-rhG-CSF,eight(20.0%)had neutropenia and grade 3 to 4 neutropenia was three(7.5%).Chemotherapy was delayed in one patients(2.5%),no fever and no antibiotic was used.The main side effects of the two groups were bone pain(15.0%vs 12.5%)and fatigue(7.5%vs 10%).Conclusion Low dose pegylated granulocyte stimulating factor can prevent neutropenia due to chemotherapy for lung cancer with high safety.