oncolog-hematolog
ro
complicaţiilor neutropenice; astfel, re- factorul de necroză tumorală sunt, de şi spitalizare, precum şi la ameliorarea
misiunile complete de boală au fost ob- asemenea, considerate factori predic- calităţii vieţii pacientului
(10)
.
ţinute într-un procent semnificativ mai tori pentru mielosupresia indusă de
mare (68,31%) la pacienţii fără astfel de chimioterapie
(33)
. O serie de parametri Concluzii
complicaţii în comparaţie cu bolnavii cu biologici, precum valorile scăzute ale 1. Complicaţiile neutropenice sunt
complicaţii neutropenice (42,22%). De neutrofilelor la diagnostic, prezenţa relativ frecvente la bolnavii cu DLBCL
asemenea, ratele de supravieţuire la 3 anemiei, valorile crescute ale LDH sau supuşi chimioterapiei citostatice. Ele
ani (83,16%) şi la 5 ani (66,33%) sunt sem- bilirubinei serice reprezintă factori care impun reducerea dozelor de citostatice
nificativ mai crescute în lotul studiat de cresc riscul apariţiei complicaţiilor la sau administrarea de factori de creştere
noi la bolnavii la care nu au fost prezente bolnavii cu DLBCL sub chimioterapie. Şi granulocitară.
complicaţii neutropenice comparativ cu la bolnavii luaţi în studiu de noi au fost 2. Prezenţa complicaţiilor neutrope-
bolnavii înregistrând astfel de complicaţii constatate diferenţe ( fără semnificaţie nice reprezintă un factor de prognostic
(5,%, respectiv 40%). statistică însă) între lotul de bolnavi la negativ pentru rata răspunsului tera-
Pe lângă chimioterapia agresivă, care modificările parametrilor amintiţi peutic şi pentru supravieţuirea bolna-
ex­istenţa unei limfopenii (sub 00/µL) erau prezente, comparativ cu lotul de vilor cu DLBCL.
bazale sau timpuriu constatate (în ziua bolnavi care nu aveau asemenea mo- 3. Valorile scăzute la diagnostic ale
a 5-a după chimioterapie) reprezintă un dificări biologice. numărului absolut de neutrofile, pre-
factor de risc crescut pentru apariţia Utilizarea de factori hematopoietici zenţa anemiei, valorile crescute ale LDH
unei neutropenii febrile
(12,2)
. Statusul de creştere ( filgrastim, pegfilgrastim) şi bilirubinei serice se asociază cu o
de performanţă precar şi valorile cres- duce la scurtarea duratei neutropeniei şi incidenţă mai crescută a complicaţiilor
cute ale receptorului ligand pentru reducerea costurilor pentru antibiotice neutropenice la aceşti bolnavi. n
Bibliografie
1. Aksoy D.Y., Tanriover M.D., Uzun O. et al. Diarrhea in neutropenic patients: a pro- therapy-induced neutropenia in febrile neutropenic patients, focusing on regi-
spective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol men-specific risk factors? A retrospective analysis. Ann Oncol 2006, 17:507-514.
2007, 18:183-189. 20. Lyman G.H., Lyman C.H., Agboola O. Risk models for predicting chemotherapy-
2. Alangaden G.J. Self-Assessment in Infectious Disease. Management of Febrile induced neutropenia. The Oncologist 2005, 10:427-437.
Neutropenia . Hospital Physician 2004: 37-38. 21. Lyman G.H., Delgado d.j. Risk and timing of hospitalization for febrile neutrope-
3. Alonso M.A.S., Ramos I.J. Lleti M.S. Antimicrobial Therapy and Prevention in fe- nia in patients receiving CHOP, CHOP-R, or CNOP chemotherapy for intermedi-
brile Neutropenia. Europ Oncolog Disease 2006:81-84. ate-grade non-Hodgkin’s lymphoma. Cancer 2003, 98:2402-2409.
4. Balducci L.Patients aged >70 Are at High Risk for Neutropenic Infection and 22. Lyman G.H., Dale D.C., Friedberg J et al. Incidence and predictors of low che-
Should Receive Hematopoietic Growth Factors When Treated with Moderately motherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide
Toxic Chemotherapy. J Clin Oncol 2001,19:1582-1585. study. J Clin Oncol 2004, 22:4302-4311.
5. Billote K.P., Mendoza M.T., Baylon H.G. infections in Febrile Neutropenia and Pos- 23. Maher D.W., Lieschke G.J., Green M et al. Filgrastim in patients with chemothera-
sible Prognostic Factors Associated with Mortality. Phil J Microbiol Infect Dis 1997, py-induced febrile neutropenia: a double-blind, placebo-controlled trial. An Intern
26 (2):55-59. med 1994, 121:492-501.
6. Brusamolino E., Rusconi C., Montalbetti L. et al. Dense-dose R-CHOP-14 sup- 24. O’Brien S.N., Blijlevens N.M.A., Mahfouz T.H et al. Infections in patients with he-
ported by pegfilgrastim in patients with diffusse large B-cell lymphoma: a phase matological cancer: recent developments. Hematoilogy (Am Soc Hematol) 2003:
II study of feasibility and toxicity. Haematologica/The hematology Journal 2006, 438-470.
91:496-502. 25. Ozer H., Mirtsching B., Rader M et al. Neutropenic events in communiity prac-
7. Cornely O.A., Uilmann A.J., Karthaus M. Evidence-based assessment of primary tices reduced by first and subsequent cycle pegfilgrastim use. The Oncologist
antifungal prophylaxis in patients with hematologic malignancies. Blood. 2003; 2007, 12:484-494.
101:3365-3372. 26. Pagano L., Mele L., Fianchi L et al. Chronic disseminated candidasis in patients
8. Cullen M., Steven N., Billingham L. et al. Antibacterial Prophylaxis after Chemo- with hematologic malignancies. Clinical features and outcome of 29 episodes.
therapy for Solid Tumors and Lymphomas. N Engl J Med 2005, 353:988-998. Haematologica 2002, 87:535-541.
9. Donowitz G.R., Maki D.G. Crnich C.J. et al. Infections in the neutropenic patient 27. Ray-Coquard I., Borg C., Bachelot Th et al. Baseline and early lymphopenia pre-
- New views of an old problem. Hematology (Am Soc Hematol) 2001:113-139. dict for the risk of febrile neutropenia after chemotherapy. Britisj Journal of Cancer
10. Doorduijn J.K., Buijt I., Van der Holt B. Et al. Economic evaluation of prophylactic 2003, 88:181-186.
granulocyte colony-stimulating factor during chemotherapy in elderly patients 28. Reichenberger F., Habicht J.M., Gratwohl A et al. Diagnosis and treatment of in-
with aggressive non-Hodgkin’s lymphoma. Haematologica 2004, 89:1109-1117. vasive pulmonary aspergillosis in neutropenic patients. Eur respir J 2002, 19:743-
11. Doorduijn J.K., Buijt I., Van der Holt B., van Imhoff G.W. et al. CHOP compared 755.
with CHOP plus granulocyte colony-stimulating factor in elderly patients with ag- 29. Salar A, Martina R, Perea G et al. High-dose infusional ifosfamide, etoposide plus
gressive non-Hodgkin’s lymphoma. J Clin Oncol 2003, 21:3041-3050. methylprednisolone followed by dexamethasone, high-dose ara-C and cisplati-
12. Gafter-Gvili A., Paul M., Fraser A et al. Antibiotic Prophylaxis in Neutropenic Pa- num and autologous stem cell transplantation for refractory or relapsed aggres-
tients. IMAJ 2007, 9:460-462. sive non-Hodgkin’s lymphoma. Haematologica 2002, 87:1028-1035.
13. Glasmacher A., Prentice A., Gorschluter M et al. Itraconazole prevets invasive 30. Seropian S, nadkarni R, Jillella A.P et al. Neutropenic infections in 100 patients
fungal infections in neutropenic patients treated for hematologic malignancies: with non-Hodgkin’s lymphoma or Hodgkin’s disease treated with high-dose
evidence from a meta-analysis of 3,597 patients. J Clin Oncol 2003, 21:4615-4626. BEAM chemotherapy and peripheral blood progenitor cell transplant: out-patient
14. Hagemeister F., Cabanillas F., Coleman M et al. The role of mitoxantrone in the treatment is a viable option. Bone Marrow Transplantation 1999, 23:599-605.
treatment of indolent lymphomas. The Oncologist 2005, 10:150-159. 31. Sharma A., Lokeshwar N. febrile neutropenia in hematological malignancies. J
15. Kannangara S. Management of febrile neutropenia. Community Oncology 2006, Postgrad 2005, 51:42-48.
3:585-591. 32. Subira M., Martino R., Franquet T. et al. Invasive pulmonary aspergillosis in pa-
16. Khorana A.A., Francis Ch.W., Culakova E. et al. Thromboembolism in hospital- tients with hematologic malignancies: survival and prognostic factors. Haemato-
ized neutropenic cancer patients. J Clin Oncol 2006, 24:484-490. logica 2002, 87:528-534.
17. Klastersky J., Paesmans M., Rubenstein E.B et al. The multinational association for 33. Voog E., Bienvenu J., Warzocha K et al. factors taht predict chemotherapy-in-
supportive care in cancer risk index: a multinational scoring system for identifying duced myelosupression in lymphoma patients: role of the tumor necrosis factor
low-risk febrile neutropenic cancer patients. J Clin Oncol 2000, 18:3038-3051. ligand-receptor system. J Clin Oncol 2000, 18:325-331.
18. Kuderer N.m., Dale D.C., Crawford J et al. Mortality, morbidity, and cost associated 34. Ziepert M., Schmits R., Trumper L et al. Prognostic factors for hematotoxicity of
with febrile neutropenia in adult cancer patients. Cancer 2006, 106:2258-2266. chemotherapy in aggressive non-Hodgkin’s lymphoma. Ann Oncol 2008, 19:752-
19. Lalami Y., Paesmans M., Muanza F et al. Can we predict the duration of chemo- 762.
Nr. 6/martie 2009
pag. 4
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68