Relationship between the pelvic bone marrow dose-volume parameters and acute hematologic toxicity in neoadjuvant pelvic intensity-modulated radiotherapy for local advance rectal cancer / 中华放射医学与防护杂志

Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.

Safety Profile and Toxicity Amelioration Strategies of Common Adverse Effects Associated with Anticancer Medications

More than half the cancer patients undergoing cancer chemotherapy develop adverse drug reactions (ADRs). Cancer chemotherapeutic agents have a lower risk-benefit ratio than other drug therapy and kill cancerous as well as the normal rapidly dividing cells including bone marrow cells, gastrointestinal epithelium, hair follicles, etc. Their main ADRs are nausea and vomiting, mucositis, constipation, diarrhea, hematological toxicities, cardiac toxicity, alopecia, gonadal toxicity pulmonary toxicity, neurotoxicity, nephrotoxicity, etc. The severity of the adverse effects may range from mild nausea to life-threatening neutropenia. Administering premedication and antidotes are very vital in these patients. Upon the occurrence of adverse effects, immediate steps should be taken to manage them. Though the ADRs due to anticancer medications are not avoidable, careful monitoring of the patients and modulating the drug schedules/dosages can help in minimizing them. Healthcare professionals should also develop strategies to minimize the occupational hazards associated with these drugs

Study on the Relationship of GSTP1(rs1695)Genetic Polymorphism with Hematological Toxicity of Autologous Hematopoietic Stem Cell Transplantation Patients / 中国药房

OBJECTIVE:To study the relationship of GSTP 1(rs1695)(simply as GSTP 1)gene polymorphism with the hematological toxicity in autologous hematopoietic stem cell transplantation(AHSCT)patients who used CBV regimen (cyclophosphamide,carmustine,etoposide). METHODS:A total of 83 AHSCT patients receiving CBV regimen were retrospective analyzed in our hospital during Apr. 2015-Jun. 2017. The gene polymorphism of GSTP 1 A313G was detected by fluorescence staining in situ hybridization. The hematological toxicity and the incidence of agranulocytosis fever,the implantation time of leukocyte,neutrophils and platelet were analyzed statistically. The relationship of GSTP 1 with above indexes were analyzed. RESULTS:Among 83 patients,gene variation was observed in one gene loci at least of 28 patients(33.73%).The gene frequency of A allele was 81.3%,while that of G allele was 18.7%. The reduce time of Ⅳ grade leukopenia,Ⅳ grade neutropenia and Ⅳgrade thrombocytopenia in GSTP 1 AA genotype patients were(8.91 ± 1.25),(9.02 ± 1.19),(11.56 ± 1.58)d after chemotherapy;those of patients with GSTP 1 313 allele G(AG/GG genotype) were(8.61 ± 1.17),(8.68 ± 1.19),(11.44 ± 1.34)d after chemotherapy. The implantation time of leukocyte,neutrophils and platelet in patients with GSTP 1 AA genotype were(11.98±1.99),(10.44±1.35),(15.55±2.18)d after autologus peripheral blood stem cell reinfusion;those of patients with GSTP1 313 allele G(AG/GG genotype)were(12.41±2.44),(10.36±1.62),(16.29±3.15)d after autologus peripheral blood stem cell reinfusion. The case number of grade Ⅲ-Ⅳ anemia were 24 and 11,accounting for 43.64% and 39.29% of corresponding genotype patients. The case number of agranulocytosis fever in patients with GSTP 1 AA genotype or GSTP 1 313 allele G(AG/GG genotype)were 21 and 11 during transplantation,accounting for 38.18% and 39.29% of corresponding genotype patients, respectively,without statistical significantly(P>0.05). CONCLUSIONS:There is no relationship between GSTP 1 gene polymorphism and hematological toxicity of AHSCT patients receiving CBV regimen.

Shenci capsule's effect on the immunologic function and hematological toxicity in the treatment of advanced non-small cell lung cancer adopting GP regime / 实用医学杂志

Objective To observe Shenci capsule's effect on immunologic function and hematological tox-icity of patients with advanced non-small cell lung cancer.Methods 60 cases of patients with advanced non-small cell lung cancer were chosen and divided into the therapy group and the control group randomly with 30 cases in each group respectively. While patients in the control group were administered simple GP chemotherapy regime, patients in the therapy group were administered Shenci capsule treatment orally in addition to the therapy in the control group.Comparisons were made of the variations in the subgroup of T lymphocyte(including the absolute val-ue of CD3+cell,the absolute value of CD4+cell,the absolute value of CD8+cell and CD4+/CD8+ratio)of hematology before and after chemotherapy between the two groups of patients. Results No significant discrepancy was found in the comparison of the absolute value of CD3+cell,the absolute value of CD4+cell,the absolute value of CD8+cell and CD4+/CD8+ratio before the chemotherapy between the two groups(P > 0.05)and the absolute value of CD3+cell,and the absolute value of CD4+cell of both groups decreased significantly after the chemotherapy(P<0.05), especially in the control group(P < 0.05). The hematological toxicity of the therapy group was lower than that in the control group(P < 0.05)after the chemotherapy. Conclusion Shenci capsule was capable of enhancing the body immunity in advanced non-small cell lung cancer and alleviating hematological toxicity.

Hematological toxicity of craniospinal irradiation and the short-term clinical efficacy in medulloblastoma / 中华放射医学与防护杂志

Objective To evaluate the hematological toxicity of craniospinal irradiation,and determine the short-term clinical efficacy and prognostic factors in medulloblastoma.Methods Eightseven patients who underwent craniospinal irradiation were retrospectively analyzed with respect to the changes in hematology during craniospinal irradiation.The effect of sex,age,tumor location,interval between surgery and radiation,interval time during radiation and radiation sequence on survival were also studied.Results The 1,2,3-year overall survival (OS) and progress-free survival (PFS) rate were 95.0％,92.4％,84.9％ and 93.7％,89.8％,80.8％,respectively.The incidence of 2-3 grade leucopenia was 90.8％,while the incidence of 1-2 grade thrombocytopenia was 70.1％,and the incidence of 3 grade thrombocytopenia was 1.1％.The incidence of 1-2 grade hemoglobin reduction was 16.1％.No patient had grade 3-4 hemoglobin reduction.Kaplan-Meier analysis shows that more favorable prognoses in terms of 3-year PFS were evident for 0-1 grade thrombocytopenia compared with 2-4 grade thrombocytopenia (x2 =3.936,P ＜ 0.05).And 3-year PFS and 3-year OS were evident for 0 grade hemoglobin reduction compared with 1-4 grade hemoglobin reduction (x2 =10.269,9.336,P ＜ 0.05).The 3-year PFS between interval time during radiation ＜ 3 days and ≥ 3 days was 84.6％ and 68.6％ (x2 =4.413,P ＜ 0.05).Conclusions Hematological toxicity during craniospinal irradiation and the interval time during radiation were prognostic factors.