| Background:Chemotherapy-induced thrombocytopenia?CIT?is a common chemotherapy toxic side effect,which may lead to a decrease in chemotherapy dose or delay in chemotherapy,or even stop chemotherapy[1],affecting clinical efficacy and increasing medical expenses[2,3].In this regard,CIT medical experts agree to propose secondary prevention.For patients with high bleeding risk,in order to prevent serious thrombocytopenia in the next chemotherapy cycle,platelet growth factor can be used prophylactically to ensure the smooth progress of chemotherapy[1].Recombinant human thrombopoietin?rhTPO?is a specific platelet growth factor that has been approved for secondary prevention of CIT[1].Capecitabine plus oxaliplatin?XELOX?or S-1 plus oxaliplatin?SOX?regimens are common chemotherapy regimens for digestive tract tumors.At present,the guideline does not specify the criteria for their CIT prevention,and the new prevention model still needs to be further explored.Objective:To evaluate the clinical efficacy of recombinant human thrombopoietin secondary prevention of thrombocytopenia induced by adjuvant chemotherapy with XELOX or SOX regimen.Methods::Prospective self-control method for comparative analysis,23 patients with stage II or above stage II thrombocytopenia?platelet count?75×109/L?who underwent XELOX or SOX adjuvant chemotherapy after radical surgery for colorectal cancer or gastric cancer.Chemotherapy cycles with first thrombocytopenia and symptomatic treatment of elevated platelet were defined as control cycle.The follow-up chemotherapy cycle with the same chemotherapy regimen and dose intensity was defined as the 1st,2nd and 3rd prophylactic cycles,and preventive subcutaneous injection of rhTPO(15000U·d-1)was given 4,3 and 2 days before chemotherapy for three consecutive preventive cycles.The changes of platelet count in each cycle were monitored.The lowest platelet count,the time of rescue treatment after thrombocytopenia,the time of interruption of chemotherapy,the time needed for platelet count to recover to?>100x109/L?,delayed chemotherapy,platelet transfusion and adverse reactions were also monitored.Results::The nadir of platelet levels in control cycle and the first prophylactic cycle after chemotherapy were?57.85±15.89?×109/L and?79.2±28.03?×109/L,P=0.002;the interruption time of chemotherapy was?3.125±3.74?days and?1.275±2.23?days,P=0.006;the rescue time was?2.7±1.87?days and?1.05±2.16?days,P=0.019;the time needed for platelet count to recover to?>100×109/L?was?9.25±2.59?days and?4.25±5.29?days,respectively,P<0.01.The nadir of platelet levels in control cycle and the second prophylactic cycle after chemotherapy was?57.7±16.44?×109/L and?73.0±19.11?×109/L,P=0.101;the time of discontinuation of chemotherapy was?3.3±4.32?days and?2.3±3.3?days,P=0.575;the time of rescue treatment was?2.3±1.34?days and?1.3±2.11?days,P=0.28;the time needed for platelet count to recover to?>100×109/L?was?9.1±3.25?days and?5.6±7.69?days,respectively,P=0.259.The nadir of platelet levels in control cycle and the third prophylactic cycle after chemotherapy was?52.8±16.44?×109/L and?89±14.58?×109/L,P=0.021;the time of discontinuation of chemotherapy was?4±5.83?days and?1±2.24?days,P=0.147;the time of rescue treatment was?3.2±0.45?days and 0days,P<0.01;the time required for platelet count to recover to?>100×109/L?was?9.6±2.61?days and?2.6±5.81?days,respectively,P=0.011.No platelets were transfused in each cycle.Three of the 23 patients were excluded because of untimely chemotherapy.Conclusion::For patients with thrombocytopenia caused by previous XELOX or SOX regimens,early prophylactic rhTPO treatment can reduce the severity of thrombocytopenia,reduce the time of rescue treatment and interruption of oral chemotherapy,ensure the intensity of chemotherapy dose and avoid delayed chemotherapy. |
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