Primarna profilaksa z granulocitne kolonije spodbujajočim dejavnikom pri bolnikih z difuznim velikoceličnim limfomom B

Potočnik, Tjaša (author), Vovk, Tomaž (mentor), Rožman, Samo (comentor)

Difuzni velikocelični limfom B je najpogostejši tip ne-Hodgkinovega limfoma. Kemoterapijska shema R-CHOP, ki vključuje kombinacijo rituksimaba, ciklofosfamida, doksorubicina, vinkristina in prednizona, predstavlja zlati standard zdravljenja bolnikov z difuznim velikoceličnim limfomom B. Nevtropenija je pogost in nevaren neželen učinek kemoterapije, ki bolnika ogrozi zaradi večje dovzetnosti za okužbo in hkrati lahko ogrozi uspešnost zdravljenja. Telesna temperatura nad 38°C ob hudi nevtropeniji pomeni febrilno nevtropenijo, ki predstavlja urgentno stanje v onkologiji in zahteva takojšnje antibiotično zdravljenje. Granulocitne kolonije spodbujajoči dejavnik pomembno skrajša obdobje nevtropenije in zmanjša tveganje za febrilno nevtropenijo. Tveganje za febrilno nevtropenijo je odvisno od vrste kemoterapije ter lastnosti bolnika. Smernice navajajo uporabo granulocitne kolonije spodbujajočega dejavnika kot primarno profilakso pri bolnikih, katerih celokupno tveganje za febrilno nevtropenijo znaša več kot 20 %. Shema R-CHOP predstavlja 19 % tveganje za razvoj febrilne nevtropenije, zato je uporaba granulocitne kolonije spodbujajočega dejavnika odvisna od presoje zdravnika, ki ovrednoti bolnikove dejavnike tveganja in oceni celokupno tveganje. Z raziskavo smo želeli preučiti uporabo granulocitne kolonije spodbujajočega dejavnika na Onkološkem inštitutu Ljubljana. V raziskavo smo vključili 197 bolnikov. S pregledom zdravstvene dokumentacije bolnikov smo preverili pojavnost nevtropenije in febrilne nevtropenije, uporabo antibiotikov, primarno profilakso z granulocitne kolonije spodbujajočim dejavnikom ter raziskali, koliko bolnikov je imelo tveganje ocenjeno z več kot 20 %. Incidenca febrilne nevtropenije v naši raziskavi je znašala 10 %. 89 % bolnikov s febrilno nevtropenijo je prejelo ustrezno antibiotično zdravljenje. Hudo nevtropenijo je razvilo 59 % bolnikov in 85 % jih je prejelo ustrezno antibiotično zaščito. Primarno profilakso je prejelo 34 % bolnikov. 56 % bolnikov je imelo ocenjeno tveganje za febrilno nevtropenijo večje od 20 % in 45 % od teh bolnikov je prejelo primarno profilakso. Dokazali smo, da uporaba granulocitne kolonije spodbujajočega dejavnika zmanjša tveganje za pojav nevtropenije 4. stopnje za 69,3%. Rezultati retrospektivne raziskave so nakazali potrebo po optimizaciji pri podajanju ocene celokupnega tveganja za febrilno nevtropenijo ter doslednem upoštevanju smernic uporabe granulocitne kolonije spodbujajočega dejavnika kot primarne profilakse za nadaljnje znižanje incidence febrilne nevtropenije in tako zagotavljati čim bolj učinkovito zdravljenje.

• Language: Slovenian
• Keywords: Granulocitne kolonije spodbujajoči dejavnik, febrilna nevtropenija, nevtropenija, kemoterapija, difuzni velikocelični limfom B
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-137477
• Publication date in RUL: 18.06.2022

Secondary language

• Language: English
• Title: Primary granulocyte colony-stimulating factor prophylaxis in patients with diffuse large B-cell lymphoma

Abstract

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. Chemotherapy regimen R-CHOP which includes cyclophosphamide, doxorubicin, vincristine and prednisone is standard of care for patients with diffuse large B-cell lymphoma. Neutropenia is a common and dangerous side effect of chemotherapy which threatens the patients due to increased susceptibility to infection and it can jeopardize the success of treatment. Febrile neutropenia is severe neutropenia with body temperature above 38°C, which is an urgent condition in oncology and requires immediate antibiotic treatment. Granulocyte colony stimulating factor significantly shortens the period of neutropenia and reduces the risk of febrile neutropenia. The risk of febrile neutropenia depends on the type of chemotherapy and the patient's characteristics. The guidelines state the use of granulocyte colony stimulating factor as primary prophylaxis in patients with overall risk of more than 20 %. The R-CHOP regimen poses 19 % risk of developing febrile neutropenia. The use of granulocyte colony stimulating factor depends on the judgment of the physician, who evaluates the patient's risk factors and assesses the patient's overall risk of febrile neutropenia. Purpose of our study was to research the use of granulocyte colony stimulating factor at Institute of Oncology Ljubljana. 197 patients were included into the study. By reviewing patients medical records we obtained data about incidence of neutropenia and febrile neutropenia, use of antibiotics, primary prophylaxis with granulocyte colony stimulating factor and researched how many patients were assessed as being at more than 20 % risk for febrile neutropenia. The incidence of febrile neutropenia was 10 %. 89 % of patients with febrile neutropenia received appropriate antibiotic treatment. Severe neutropenia developed in 59 % of patients and 85 % of them received appropriate antibiotic protection. 34 % of patients received primary prophylaxis. 56 % of patients had an estimated risk of febrile neutropenia greater than 20 % and 45 % of these patients received primary prophylaxis. The results show that the use of granulocyte colony stimulating factor reduces the risk of stage 4 neutropenia by 69,3 %. Results of the retrospective study highlighted the need for optimization in assessment of overall risk of febrile neutropenia and consistent implementation of granulocyte colony stimulating factor as primary prophylaxis according to guidelines to further reduce the incidence of febrile neutropenia and thus ensure the most effective treatment.

• Keywords: Granulocyte colony stimulating factor, febrile neutropenia, neutropenia, chemotherapy, diffuse large B-cell lymphoma