Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update
Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update
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DOI：
10.1200/jco.2015.62.3488
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发表时间：
2015-10-01
影响因子：
45.3
通讯作者：
Armitage, James O.
中科院分区：
文献类型：
--
作者：
Smith, Thomas J.;Bohlke, Kari;Armitage, James O.
目的更新2006年美国临床肿瘤学会关于使用造血集落刺激因子(CSF)的指南。方法美国临床肿瘤学会召集了一个更新委员会，对2005年10月至2014年9月期间的随机临床试验、荟萃分析和系统评价进行了系统综述。指南的建议是基于更新委员会对证据的审查。结果与以前的建议相比，变化包括增加了tbo-filgrtimm和figrgrtimsndz，适度地推荐在老年弥漫性侵袭性淋巴瘤患者中常规使用CSF，并增加了反对淋巴瘤常规剂量密度化疗而支持在尿路上皮癌中进行高剂量强度化疗的建议。更新委员会没有讨论有关在成人急性髓系白血病或骨髓增生异常综合征中使用CSF的建议。建议当发热性中性粒细胞减少症的风险约为20%或更高，并且没有其他同样有效和安全的不需要CSFS的方案可用时，有必要预防性使用CSF来降低发热中性粒细胞减少的风险。根据高危患者的年龄、病史、疾病特征和化疗方案的骨髓毒性，建议采用一级预防措施来预防高危患者的中性粒细胞减少症。需要CSF的剂量密集型方案只应在适当设计的临床试验中使用，或者在有令人信服的疗效数据支持的情况下使用。目前对暴露于致命剂量全身放射治疗的患者的管理建议包括立即给予CSF，但剂量不够高，不足以导致其他器官损伤而确定死亡。(C)2015年度美国临床肿瘤学会
PurposeTo update the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors (CSFs).MethodsThe American Society of Clinical Oncology convened an Update Committee and conducted a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014. Guideline recommendations were based on the review of the evidence by the Update Committee.ResultsChanges to previous recommendations include the addition of tbo-filgrastim and filgrastim-sndz, moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma, and addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high-dose-intensity chemotherapy in urothelial cancer. The Update Committee did not address recommendations regarding use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults.RecommendationsProphylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. Dose-dense regimens that require CSFs should only be used within an appropriately designed clinical trial or if supported by convincing efficacy data. Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs. (C) 2015 by American Society of Clinical Oncology