Baseline and early lymphopenia predict for the risk of febrile neutropenia after chemotherapy.
Baseline and early lymphopenia predict for the risk of febrile neutropenia after chemotherapy.
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DOI：
10.1038/sj.bjc.6600724
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发表时间：
2003-01-27
影响因子：
8.8
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基于早期（第5天）淋巴细胞减少和化疗剂量，描述了常规细胞毒化疗后发热性中性粒细胞减少（FN）的风险模型。在日常实践中，基于第一天可用参数的风险指数会更容易。这项工作的目的是（1）研究仅使用第1天血细胞计数的FN风险模型和（2）比较第1天和第5天的风险模型。三个系列的患者用于描述和/或验证这两种风险模型：（1）1996年在CLB内科治疗的950名患者的详尽队列（CLB-1996系列），（2）Elypse 1系列，一个在社区医院和区域癌症中心治疗的321名患者的前瞻性系列，和（3）先前报道的329例患者的Elypse 0系列。所有三个系列的第1天血细胞计数均可用，而第5天血细胞计数仅在Elypse 0和1系列中可用。在CLB-1996系列中，92例（9.7%）患者发生FN;在多变量分析中，只有化疗剂量和第1天淋巴细胞减少<700 μl−1对FN有独立的预后价值。在CLB-1996中，在具有两种风险因素的患者（“高风险组”）中，FN的发生率分别为44、50和61%。Elypse 1和0系列，分别表明“第1天”的风险模型，使人们能够识别FN的高风险患者。此外，在“第5天”模型的高风险组（即第5天淋巴细胞减少≥ 700 μl−1并接受高风险CT的患者）中观察到的FN发生率在Elypse 0和1系列中分别为45%和69%。在Elypse 1和0系列中，发生FN的所有患者中有15%和12%属于“第1天”风险模型的高风险组，而“第5天”风险模型的高风险组分别为25%和62%。在接受化疗的患者中，第1天和第5天淋巴细胞减少症均与FN风险增加相关。“第1天”模型识别了FN高风险的小群体患者，但灵敏度低于第5天模型。
A risk model for febrile neutropenia (FN) after conventional cytotoxic chemotherapy, based on early (day 5) lymphopenia and the dose of chemotherapy, has been described. A risk index based on parameters available at day 1 would be easier in daily practice. The objectives of this work were (1) to investigate a risk model for FN using only day 1 blood cell count and (2) to compare the day 1 and day 5 risk models. Three series of patients were used for the delineation and/or validation of these two risk models: (1) the exhaustive cohort of 950 patients treated in the Department of Medicine of the CLB in 1996 (CLB-1996 series), (2) the Elypse 1 series, a prospective series of 321 patients treated in community hospitals and regional cancer centres, and (3) a previously reported Elypse 0 series of 329 patients. Day 1 blood cell count was available in all three series, while day 5 blood cell count was available only in the Elypse 0 and 1 series. In the CLB-1996 series, 92 (9.7%) patients experienced FN; only chemotherapy dose and day 1 lymphopenia ⩽700 μl−1 had an independent prognostic value for FN in multivariate analysis. In patients with both risk factors (‘high-risk group’), the incidence of FN was 44, 50 and 61% in the CLB-1996. Elypse 1 and 0 series, respectively, indicating that the ‘day 1’ risk model enables one to identify patients at high-risk for FN. Besides, the observed incidence of FN in the high-risk group of the ‘day 5’ model (i.e. patients with day 5 lymphopenia ⩽700 μl−1 and receiving high-risk CT) was 45 and 69% in the Elypse 0 and 1 series, respectively. In the Elypse 1 and 0 series, 15 and 12% of all patients who experienced FN were in the high-risk group of the ‘day 1’ risk model as compared to 25 and 62% for the high-risk group of the ‘day 5’ risk model. Both day 1 and day 5 lymphopenia are associated with an increased risk of FN in patients treated with chemotherapy. The ‘day 1’ model identifies a small population of patients at high risk for FN, but has a lower sensitivity than the day 5 model.