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Akut lenfoblastik lösemili çocuklarda gelişen ateşsiz nötropeniye yaklaşım yöntemlerinin karşılaştırılması (Geriye dönük çalışma)

Başlık çevirisi mevcut değil.

  1. Tez No: 175130
  2. Yazar: ŞÜKRÜ PAKSU
  3. Danışmanlar: DOÇ. DR. TUNÇ FIŞGIN
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
  6. Anahtar Kelimeler: Acute lymphoblastic leukemia, afebril neutropenia, high-dose methyl prednisolone, granulocyte colony stimulating factor, Acute lymphoblastic leukemia, afebril neutropenia, high-dose methyl prednisolone, granulocyte colony stimulating factor
  7. Yıl: 2007
  8. Dil: Türkçe
  9. Üniversite: Ondokuz Mayıs Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 64

Özet

There is no agreed upon follow-up and treatment protocol in the literature in the approach to afebrile neutropenia and related treatment delay encountered during the maintenance therapy of acute lymphoblastic leukemia (ALL). The objectives of this study are the investigation of the influences of high-dose methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced afebrile neutropenia encountered in children with ALL receiving maintenance therapy, and comparison of the findings with those of the patients who did not receive such a supplementation. Sixty-four afebrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol in Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology followed between December 2004 - June 2005, were evaluated retrospectively. Of these patients, 15 (51,7%) were male and 14 (48,3%) were female. The mean age of the patients was 7,9 (2,8-17,6) years. While in 21 (32,8%) of 64 neutropenic attacks, no additional treatment to shorten the duration of attack was given; single dose (20 mg/kg/day) methyl prednisiolone and G-CSF (5 mcg/kg/day) were administered in 26 (40,6%) and 17 (26,6%) incidents, respectively. Patients receiving G-CSF treatment were admitted to the hospital while the others were managed on outpatient basis. Neutropenia appeared most frequently after the vepeside-cyclophospamide administration week. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically, the difference between the HDMP and G-CSF groups were not statistically significant. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. The patients were divided into two groups according to the neutrophil counts as mild - moderate and severe neutropenia. In both groups, second day and overall success rates were significantly higher in patients treated with HDMP or G-CSF compared to clinical observation group. However the differences were not significant in fourth day success rates between the groups. The patients were evaluated in two groups according to wheter or not receiving a myelopoiesis inducing agent to shorten the VIIduration of neutropenia. In the group receiving myelopoiesis induction therapy both the success rates and the neutrophil counts were found significantly higher than the others. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients, and no side effects severe enough to discontinue the treatment emerged. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Other than prominent elevation in monocyte counts of the G-CSF group, no significant difference between the groups in other hematological parameters was detected. In conclusion especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in patients with ALL receiving maintenance therapy due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.

Özet (Çeviri)

There is no agreed upon follow-up and treatment protocol in the literature in the approach to afebrile neutropenia and related treatment delay encountered during the maintenance therapy of acute lymphoblastic leukemia (ALL). The objectives of this study are the investigation of the influences of high-dose methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced afebrile neutropenia encountered in children with ALL receiving maintenance therapy, and comparison of the findings with those of the patients who did not receive such a supplementation. Sixty-four afebrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol in Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology followed between December 2004 - June 2005, were evaluated retrospectively. Of these patients, 15 (51,7%) were male and 14 (48,3%) were female. The mean age of the patients was 7,9 (2,8-17,6) years. While in 21 (32,8%) of 64 neutropenic attacks, no additional treatment to shorten the duration of attack was given; single dose (20 mg/kg/day) methyl prednisiolone and G-CSF (5 mcg/kg/day) were administered in 26 (40,6%) and 17 (26,6%) incidents, respectively. Patients receiving G-CSF treatment were admitted to the hospital while the others were managed on outpatient basis. Neutropenia appeared most frequently after the vepeside-cyclophospamide administration week. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically, the difference between the HDMP and G-CSF groups were not statistically significant. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. The patients were divided into two groups according to the neutrophil counts as mild - moderate and severe neutropenia. In both groups, second day and overall success rates were significantly higher in patients treated with HDMP or G-CSF compared to clinical observation group. However the differences were not significant in fourth day success rates between the groups. The patients were evaluated in two groups according to wheter or not receiving a myelopoiesis inducing agent to shorten the VIIduration of neutropenia. In the group receiving myelopoiesis induction therapy both the success rates and the neutrophil counts were found significantly higher than the others. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients, and no side effects severe enough to discontinue the treatment emerged. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Other than prominent elevation in monocyte counts of the G-CSF group, no significant difference between the groups in other hematological parameters was detected. In conclusion especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in patients with ALL receiving maintenance therapy due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.

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