| [Background] Chemotherapy induced thrombocytopenia (CIT) is one of the common side effects of chemotherapy,which increasing the risk of bleeding in patients and having a bad effect on prognosis of the patients. Recombinant human thrombopoietin (rhTPO) as a platelet specific stimulating factor,widely used in the treatment of thrombocytopenia after chemotherapy. There is increasing interest in preventive usage,to reduce the duration and extent of thrombocytopenia. At present,the feasibility and necessity of preventive treatment are also recognized. There have been reported about 3 days before the start of chemotherapy to receive the continuous injection of rhTPO untill a week to prevent CIT of malignant tumor patients after chemotherapy[1]. There have also been reported on the use of rhTPO for the prevention of CIT in the patients with non small cell lung cancer(NSCLC) at 2,4,6,9 days after gemcitabine plus platinum chemotherapy[2]. Vadhan-Raj developed two multi group parallel controlled trials,platinum-based chemotherapy of gynecological cancer patients[3] and ifosfamide plus doxorubicin chemotherapy of patients with sarcoma[4] giving rhTPO . The results were showed that multiple intervals medication after chemotherapy with rhTPO[3] and the administration regimen of before and after chemotherapy[4] were safe and effective. But there are few reports about the intermittent prophylactic administration before and after chemotherapy at home and abroad. Timing and frequency of administration are still lack of credible standards and guidelines,which need further test and try.[Objective] To evaluate the efficacy and safety of rhTPO in the prevention of CIT in patients with malignant solid tumor before and after chemotherapy .[Methods ] A randomized self controlled experimental method was used. 20 patients with malignant solid tumor of receiving chemotherapy,with grade 3-4 thrombocytopenia (platelet<50×109/L),as blank control,marked A phase. Preventive use of rhTPO in the next period of chemotherapy was recorded as a prophylactic cycle,marked B phase. Administration program: rhTPO should be given, 15000U,subcutaneous injection,on second,first days before the start of chemotherapy and fourth,ninth days after the start of chemotherapy (first days of chemotherapy to start the diary for the days). Chemotherapy day was recorded as the first day of the cycle.Dynamic detection and recording of blood routine,liver and kidney function,blood coagulation function,vital signs and adverse reactions need to be made.[Results] The minimal mean platelet count and maximal mean platelet count were higher in preventive administration rhTPO phase than blank period after chemotherapy,respectively,(66.4 ± 25.9)× 1 09/L vs(40.1 ± 11.3)±109/L,P=0.019 and(259.2 ± 122.3) ×109/L vs (144.4 ± 60.0) ×109/L,P=0.021. The recovery days of thrombocytopenia?75×109/L and ?100×109/L was shortened,as well as the duration days of CIT,which had statistical significance. There were 2 patients had no CIT in the treatment period,accounted for 10% of patients enrolled in the group. The two patients with stage 4 thrombocytopenia in the blank period,occurred stage 3 thrombocytopenia in the treatment period. No significant adverse reactions occurred in the prevention period. Red blood cells,white blood cells,liver and kidney function,blood coagulation function were not obviously abnormal before and after treatment.[Concludion ] Before and after chemotherapy,the intermittent prophylactic application of rhTPO can effectively reduce the degree and duration of thrombocytopenia after chemotherapy in patients with malignant solid tumor who occured CIT in the last phase. |
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