The clinical application of cancer chemotherapy drugs, (1) treatment with conventional dose chemotherapy-induced neutropenia
After the chemotherapy, neutropenia but no fever patients, neutropenia appeared on the application of CSFs is not much benefit to patients; the merger fever patients, as often with severe infection, sepsis, shock, and more organ failure, the application of CSFs and antibiotics to prevent these serious complications.
G-CSF treatment on chemotherapy-induced febrile neutropenia in large-scale study was conducted in Australia. After all the chemotherapy, febrile neutropenia were randomized to receive G-CSF 12g/kg/d, while application of antibiotics, or antibiotic treatment alone. The results show, G-CSF treatment group, the neutrophil recovery time to normal faster than the control group only 1 day, but the duration of fever, time of application of antibiotics were significantly shorter length of stay in treatment group than the control group shorten the 11 days. Other studies have obtained similar results.
(2) by increasing the drug dose and / or shorten the interval to increase chemotherapy dose intensity of chemotherapy
Chemotherapy dose intensity is critical to achieving effective to improve the dose intensity in some tumors can be significantly improved response rates, such as breast cancer and malignant lymphoma. But also more severe bone marrow suppression. CSFs can increase chemotherapy dose intensity of 8% -20%, is conducive to better effect.
Most of the foreign clinical studies have shown that application of CSFs can significantly reduce the increased dose intensity of chemotherapy induced neutropenia level. Improve the dose at the same time, to avoid prolonged cycle of chemotherapy or due to chemotherapy toxicity of drug reduction. If you expect to receive from a chemotherapy dose intensity may occur in 40% of febrile neutropenia, support should consider the use of CSFs.
The clinical application of cancer chemotherapy drugs (3) Prevention of conventional-dose chemotherapy-induced neutropenia
For the first receiving cytotoxic chemotherapy, patients, patients after chemotherapy if the expected neutropenia may occur, the application of CSFs to make such a complication rate was decreased by 50%. However, less bone marrow suppression and would not have febrile neutropenic patients, prophylactic use of CSFs are of little value. This application is called primary prevention. Tumors of patients with newly diagnosed, primary prevention should not be used as regular medication.
For the experienced febrile neutropenia in patients with prophylactic use of CSFs is called secondary prevention, it can significantly reduce the recurrence of febrile neutropenia incidence, while bone marrow suppression will not result in reduction of drug dose or to postpone chemotherapy.
Crawford and so on acceptable CAE (cyclophosphamide, doxorubicin, and etoposide) chemotherapy for patients with small cell lung cancer screening, to the first cycle of chemotherapy after the febrile patients with neutropenia after chemotherapy in the next cycle Prophylactic G-CSF, the results of the second cycle of neutropenia was significantly shorter duration (first period of 6 days, the second period of 2.5 days), and neutropenia caused by the proportion of heat from 100% to 23%.
The clinical application of cancer chemotherapy drugs (4) for the bone marrow (peripheral blood stem cell) transplantation
High-dose chemotherapy combined with autologous bone marrow (peripheral blood stem cell) transplant patients, CSFs can shorten neutropenia duration, reduce the incidence of infectious complications. Therefore, commonly used in bone marrow (peripheral blood stem cells) after transplantation of hematopoietic function recovery. Meanwhile, the mobilization before transplantation, CSFs combination chemotherapy is currently recognized as an effective way.
The clinical application of cancer chemotherapy drugs (5) for the adjuvant treatment of myeloid malignancies
Can be used to induce acute myeloid leukemia after chemotherapy, neutropenia disease treatment. Myelodysplastic syndrome (MDS) patients with severe neutropenia and recurrent infections may be intermittently CSFs, but not in favor of long-lasting medication.
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