Prophylactic recombinant human granulocyte/granulocyte-macrophage colony-stimulating factor in children with hematologic malignancies after chemotherapy / 肿瘤

ABSTRACT

Objective: To analyze the efficacy and adverse effects of post-chemotherapy prophylactic recombinant human granulocyte/granulocyte-macrophage colony-stimulating factor (rhG/GM-CSF) in children with hematologic malignancies. Methods: The time of neutrophil recovery and the incidence rates of infection and adverse events of prophylactic use of rhG/GM-CSF within 24-48 h after chemotherapy in children with high-risk acute lymphoblastic leukemia/lymphoblastic lymphoma (HR-ALL/LBL), acute myeloid leukemia (AML) or B-cell non-Hodgkin's lymphoma (B-NHL) were compared. Results: There were 248 cases included in this study between January 2013 and December 2015. The average time for the patients to recover their neutrophils was 11.6 d [95% confidence interval (CI ) 11.1-12.0 d] for all patients, 10.8 d (95% CI 10.1-11.4 d) for those treated with rhG-CSF, and 12.7 d (95% CI 11.9-13.4 d) for rhGM-CSF. The neutrophil recovery time of rhG-CSF group was significantly shorter than that of rhGM-CSF group (z = 4.649, P<0.01). AML patients recovered neutrophils later than patients with HR-ALL/LBL (z = 4.819, P<0.01) and B-NHL (z = 5.595, P<0.01). Patients treated with protocols containing high-dose cytosine arabinoside, whose neutrophil recovery time was significantly longer than the patients in other protocol groups (z = 5.417, P<0.01). There was 58.9% of patients in rhG-CSF group had febrile neutropenia (FN), and the rate of FN for rhGM-CSF was 57.8%; there had no statistical difference between the two groups (P = 0.87). HR3 protocol led to the highest FN rate (88.0%) among all protocols. Infection-related deaths in 2 patients were recorded, one in rhG-CSF group and suffered from B-NHL who later developed sepsis after BB protocol, and the other patient had HR-ALL and was in rhGM-CSF group, who was treated with HR3 protocol and died of multi-drug resistant pseudomonas aeruginosa sepsis. Conclusion: The post-chemotherapy prophylactic use of rhG/GM-CSF in children with hematologic malignancies is safe, however larger randomized clinical trials to validate the efficacy in the prevention of infection after chemotherapy is required.