Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia
Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia
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DOI：
10.1200/jco.2001.19.4.1137
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发表时间：
2001-02-15
影响因子：
45.3
通讯作者：
Benjamin, RS
中科院分区：
文献类型：
--
作者：
Elting, LS;Rubenstein, EB;Benjamin, RS
目的：描述与化疗诱导的血小板减少症（血小板<50，000/L）相关的出血和化疗剂量调整的发生率和结局。患者和方法：对609例实体瘤或淋巴瘤患者在1，262个化疗周期中并发血小板减少症的出血、延迟或减少后续周期的剂量、生存率、土地资源利用进行随访。使用考克斯比例风险模型检查生存与出血或剂量调整之间的关联。通过Logistic回归分析确定诱发因素。在既往出血事件的患者中，9%的周期发生出血（P < .0001），基线血小板低于75，000/L（p < .0001），骨髓转移（P = 0.001）、体力状态不佳（P = 0.03）以及顺铂、卡铂、卡莫司汀或洛莫司汀给药（P = 0.0002）。大出血事件导致生存期缩短和资源利用率升高（P <0.0001）。化疗延迟发生在6%的患者中，有超过5个周期（P = 0.003），放疗（P = 0.03）和播散性疾病（P = 0.04）。他们经历了类似的临床结局，但使用了更多的资源。在15%的周期内发生剂量减少，但与临床结局不良或过度资源利用无关。显着缩短生存期和更高的资源利用率，观察20%的患者谁没有达到足够的反应，血小板transfusion.Conclusion：出血的发生率是低的实体瘤患者的整体，但超过20%，在某些亚组。使用常规可用的临床信息，这些亚组很容易识别。正在制定临床预测规则。对血小板输注的不良反应是血小板减少症的临床和经济上显著的下游效应，需要进一步研究。
Purpose: To describe the incidence and outcomes of bleeding and chemotherapy dose modifications associated with chemotherapy-induced thrombocytopenia (platelets < 50,000/L).Patients and Methods: Six hundred nine patients with solid tumors or lymphoma were followed-up during 1,262 chemotherapy cycles complicated by thrombocytopenia for development of bleeding, delay or dose reduction of the subsequent cycle, survival, land resource utilization. The association between survival and bleeding or dose modification was examined using the Cox proportional hazards model. Predisposing factors were identified by logistic regression.Results: Bleeding occurred during 9% of cycles among patients with previous bleeding episodes (P < .0001), baseline platelets less than 75,000/L (p < .0001), bone marrow metastases (P = .001), poor performance status (P =.03), and cisplatin, carboplatin, carmustine or lomustine administration (P = .0002). Major bleeding episodes resulted in shorter survival and higher resource utilization (P < .0001). Chemotherapy delays occurred during 6% of cycles among patients with more than five previous cycles (P = .003), radiotherapy (P =.03), and disseminated disease (P = .04). They experienced similar clinical outcomes but used significantly more resources. Dose reductions occurred during 15% of cycles but were not associated with poor clinical outcomes or excess resource utilization. Significantly shorter survival and higher resource utilization were observed among the 20% of patients who failed to achieve an adequate response to platelet transfusion.Conclusion: The incidence of bleeding is low among solid tumor patients overall but exceeds 20% in some subgroups. These subgroups are easily identifiable using routinely available clinical information. A clinical prediction rule is being developed. Poor response to platelet transfusion is a clinically and financially significant downstream effect of thrombocytopenia and warrants further investigation.