Toxicity Of Hematopoiesis System Caused By High Dose Chemotherapy For Bone And Soft Sarcoma:Analysis Of The Risk Factors And Countermeasures

Objective:To analyze and research the relevant risk factor of myelosuppression caused by high dose combined chemotherapy;To preserve clinical evidence for making more reasonable chemotherapy protocol.Methods:Selected and retrospectively studied113patients with bone and soft sarcoma from the second hospital of xiangya(from June2007to April2012).The specific character and information of all patients could be seen in followed table.All Patients were diagnosed definitely including the preoperative X-ray and CT or MRI,blood-test and pathological diagnose;All patients received high dose combined chemotherapy. The regimen of combined chemotherapy was implemented as follows:HD-MTX/VCR+DDP/THP-ADM+IFO.The dose of chemotherapy drugs was calculated according to the body surface area and some factors such as the age and the constitution of the patients should be considered. The specific protocol can be seen in the appendix1.All patients were divided into two groups according to the degree of the toxicity of hemopoiesis system with the American toxicity standard for the reference.Group A was the group in which the patients suffering from grade3or above toxicity of hemopoiesis system.Respectively Group B patients was the group in which the patients suffering from grade2or below toxicity of hemopoiesis system.We monitored the change of the clinical performance of all patients and recorded the number,the kind and the degree of the toxicity of all patients during the time of chemotherapy,then we tabulated all the data and analyze all data by using statistics methods.First we did univariate analysis for the risk factors which were relevant to the myelosuppression caused by chemotherapy,then we chose the significant factors (P<0.05) and did multiple logistic regression analysis for them.Results:There were68patients suffering from grade3or above myelosuppression with the incidence of62.8%%in all patients including21patients suffering from grade4myelosuppression with the rate of 18.58%(less than the rate of many research reports),respectively there were45suffering from grade2or below myelosuppression with the incidence of37.2%%in all patients.11patients got FN including4patients suffering from grade1or2pulmonary infection.However, after the timely treatment including use of G-CSF, antibiotics and blood transfusion,all patients who experienced serious myelosuppression recovered completely and no patients died of grade4myelosuppression.In the univariate analysis,the significant factors(P<0.05) were as follows:age(less than20years),KPS(less than60),malnutrition, subnormal WBC(before chemotherapy),forepassed chemotherapy(more than3times),combined chemotherapy(more than3kinds).In the multiple logistic regression analysis,the significant factors were as follows:age(less than20years),KPS(less than60),forepassed chemotherapy(more than3times),combined chemotherapy(more than3kinds).Conclusions:1.There was high degree hematological toxicity in the protocol we used for the patients suffering from bone and soft tissue sarcoma.The toxicity of the protocol should be adjusted for some degree to reduce the toxicity of the protocol.2.The risk actors as follows:age (less than20years), KPS (less than60),malnutrition, forepast chemotherapy (more than3times),combined chemotherapy(more than3kinds) are obviously relevant to the myelosuppression (grade3or above) caused by the HD-chemotherapy.3.The countermeasures for the myelosuppression were effective.