Comparative effectiveness of white blood cell growth factors on neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma treated with chemotherapy.
Comparative effectiveness of white blood cell growth factors on neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma treated with chemotherapy.
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白细胞生长因子对接受化疗的非霍奇金淋巴瘤老年人的中性粒细胞减少症、感染和生存的比较效果。
DOI：
10.1111/j.1532-5415.2010.03081.x
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发表时间：
2010
影响因子：
6.3
通讯作者：
Du,XianglinL
中科院分区：
文献类型：
--
作者：
Gruschkus,StephenK;Lairson,David;Dunn,JKay;Risser,Jan;Du,XianglinL
目的：确定集落刺激因子（CSF）对接受化疗的老年非霍奇金淋巴瘤（NHL）患者的发热性中性粒细胞减少症、感染和生存率的影响。设计：回顾性队列研究。背景：监测、流行病学和最终结果-医疗保险数据库。参与者：13223名65岁及以上的NHL患者（平均年龄74.9岁，范围65-102）在1992年至2002年接受化疗的诊断。二级预防定义为发热性中性粒细胞减少症或感染后使用CSF。结果：在调整年龄、分期、组织学和合并症后，给予5 - 9次初级预防性CSF的参与者发热性中性粒细胞减少症的风险降低42%（优势比（OR）=0.58，95%置信区间（CI）=0.41-0.83），给予10次或更多次CSF的参与者发热性中性粒细胞减少症的风险降低48%（OR=0.52，95%CI =0.36-0.76）。调整接受CSF的倾向评分后，结果无显著差异。一级预防性CSF与总生存率之间无显著相关性，但二级预防性CSF与更好的生存率显著相关。4 - 10次二级预防性CSF给药与死亡风险降低9%相关（风险比（HR）=0.91，95% CI=0.84-0.99），11 - 23次给药与死亡风险降低23%相关（HR=0.77，95% CI=0.71-0.84）和24次或更多次给药与死亡风险降低13%相关（HR=0.87，95% CI+0.79-0.95）。结论：一级预防性CSF可有效降低中性粒细胞减少和感染的发生率。这些发现证实了推荐接受化疗的NHL老年人预防性CSF的临床指南。
OBJECTIVES:To determine the effect of colony‐stimulating factor (CSF) on incidence of febrile neutropenia, infection, and survival in older people with non‐Hodgkin's lymphoma (NHL) treated with chemotherapy.DESIGN:Retrospective cohort study.SETTING:The Surveillance, Epidemiology, and End Results–Medicare database.PARTICIPANTS:Thirteen thousand two hundred twenty‐three people diagnosed with NHL at age 65 and older (mean age 74.9, range 65–102) in 1992 to 2002 who received chemotherapy within 12 months of diagnosis.MEASUREMENTS:Primary prophylaxis was defined as CSF administered at the start of chemotherapy before febrile neutropenia or infection; secondary prophylaxis was defined as CSF use after febrile neutropenia or infection.RESULTS:Participants with five to nine administrations of primary prophylactic CSF had a 42% lower risk of febrile neutropenia (odds ratio (OR)=0.58, 95% confidence interval (CI)=0.41–0.83), and participants with 10 or more administrations had a 48% lower risk (OR=0.52, 95% CI=0.36–0.76) after adjusting for age, stage, histology, and comorbidity. Results did not differ significantly after adjusting for propensity score of receiving CSF. There was no significant association between primary prophylactic CSF and overall survival, but secondary prophylactic CSF was significantly associated with better survival. Four to 10 administrations of secondary prophylactic CSF was associated with 9% lower mortality risk (hazard ratio (HR)=0.91, 95% CI=0.84–0.99), 11 to 23 administrations was associated with 23% lower mortality risk (HR=0.77, 95% CI=0.71–0.84) and 24 or more administrations was associated with 13% lower mortality risk (HR=0.87, 95% CI+0.79–0.95) than in participants not receiving CSF after neutropenia or infection.CONCLUSION:Primary prophylactic CSF was observed to be effective in reducing the incidence of neutropenia and infection. These findings substantiate the clinical guidelines for recommending prophylactic CSF in older people with NHL receiving chemotherapy.