[Consensus on clinical diagnosis, treatment and prevention management of chemotherapy induced thrombocytopenia in China(2018)].
[Consensus on clinical diagnosis, treatment and prevention management of chemotherapy induced thrombocytopenia in China(2018)].
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DOI：
10.3760/cma.j.issn.0253-3766.2018.09.014
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发表时间：
2018-09-23
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化疗诱导的血小板减少症（CIT）是癌症患者化疗常见的副作用，会导致剂量和周期减少或化疗延迟，甚至需要输注血小板。因此，CIT显著增加了治疗费用，降低了化疗的疗效和生活质量，缩短了患者的生存时间。CIT的治疗主要包括输注血小板、重组人血小板生成素（rhTPO）和重组人白细胞介素-11（rhIL-11）。RhIL-11是第一个被批准的血小板生成细胞因子。白细胞介素-11已被证明在血小板减少症的治疗中是有效的。RhTPO是一种重组全长糖基化血小板生成素，是c-Mpl蛋白的配体。一些观察结果表明，化疗前后给予rhTPO可能对患者有益，可促进血小板恢复并减少中度骨髓抑制方案后的血小板减少症。近年来，rhTPO在CIT治疗中的应用极大地改变了CIT的管理和治疗方案。中国临床肿瘤学会（CSCO）于2014年发表了关于CIT的共识。基于此，专家委员会根据近期文献和临床研究，更新了《中国化疗所致血小板减少症临床诊断、治疗和预防管理共识（2018）》。新的CIT循证医学实践共识旨在为CIT患者提供更合理的诊断、治疗和预防方案，以维持血小板计数的正常。
Chemotherapy induced thrombocytopenia (CIT) is a common side-effect of chemotherapy in cancer patients, which lead to dose and cycle reduction or chemotherapy delay, or even the need of platelet transfusion. Therefore, CIT significantly increases the cost of treatment, reduces the efficacy of chemotherapy and the quality of life, and shortens the survival time of patients. The main treatments of CIT include transfusion of platelets, recombinant human thrombopoietin (rhTPO), and recombinant human interleukin-11 (rhIL-11). RhIL-11 is the first approved thrombocytopoietic cytokine. Interleukin-11 has been shown to be effective in the treatment of thrombocytopenia. RhTPO is a recombinant full-length glycosylated thrombopoietin, which is a ligand for c-Mpl protein. Several observations indicated that administration of rhTPO before and after chemotherapy might be beneficial to patients, which enhances platelet recovery and reduces thrombocytopenia after moderately myelosuppressive regimens. In recent years, the application of rhTPO in CIT treatment has dramatically changed the management and treatment plan of CIT. The China Society of Clinical Oncology (CSCO) published a consensus on CIT in 2014. Based on this, the expert committee updated "Consensus on clinical diagnosis, treatment and prevention management of chemotherapy induced thrombocytopenia in China (2018)" according to the recent literature and clinical research. The new evidence-based practice consensus for CIT aims to provide more reasonable diagnosis, treatment of prevention regimens for CIT patients to maintain the normal platelet counts.