고형암 환자에 있어서 조혈세포 촉진인자의 사용시점에 관한 현황과 적정 투여시점에 대한 고찰 = Drug Use Status and Optimal Administration Time of Colony-Stimulating Factor(CSF) for Solid Cancer Patients

다국어 초록 (Multilingual Abstract)

The neutropenia is one of the most critical adverse effects of chemotherapy. Prophylaxis of neutropenia is very important because neutropenic patients are susceptible to infection, which is one of the leading cause of death. American Society of Clinical Oncology recommends that CSF as prophylactic should be given 24 to 72 hours after the administration of myelotoxic chemotherapy. The purpose of this study is to investigate the CSF administration timing and clinical effectiveness of CSF on neutropenia prophylaxis according to initiating time. Data were collected retrospectively from Electronic Medical Record of solid cancer patients who have been administrated prophylactic CSF after chemotherapy in Seoul National University Bundang Hospital from January 1st to June 30th in 2007. Patients were divided into two different groups, based on timing of CSF initiation after chemotherapy. One group being administrated CSF within 24 hours and another group after 24 hours. Related parameters such as age, diagnosis, chemo-regimen and chemotherapy history as well as ANC, development of fever, infection, antibiotic use, and delay to next chemotherapy were investigated. 79 cases were enrolled, and 55 cases were within 24 hours and 24 cases were after 24 hours. Hematology-oncology patients were administrated CSF after 24 hours in most cases, Obstetrics and gynecology(OBGY) patients were administrated it in the same day when chemotherapy finished then there were more cases that CSF was given within 24 hours in OBGY. From two groups we found 8 cases (14.5%), 7 cases (29.2%) of neutropenia in group within 24 hours and after 24 hours, 7 cases (12.7%), 3 cases (23.5%) of fever, 2 cases(3.6%), 1 case(4.2%) of infection and 6 cases (10.9%), 5 cases (20.9%) of antibiotics usage. 7 cases (3 patients, 12.7%) and 0 case of delay to next chemotherapy as a result of neutropenia were found. No statistical difference could be observed. There were more cases of multi-organ metastasis and antitumor agent dose reduction demands in patients’group who experienced neutropenia. These patients were at worse performance state, and were to be considered as more important factors that influenced neutropenia. Universal recommendation on optimal timing of CSF initiation cannot be made and no statistical difference was found in this study. In the future detailed classification of patients can be conducted in another experiments to enhance the study over this subject.

참고문헌 (Reference)

1 김정숙, "항암요법을 받은 암환자에서의 감염 및 치료 경향" 17 (17): 481-, 2000

2 Howard Ozer, "Somerfield for the American Society of Clinical Oncology Growth Factors Expert Panel. : 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines" 18 : 3558-, 2000

3 G. Koumakis, "Optimal timing(Preemptive versus supportive) of Granulocyte colony-stimulating factor administration following high-dose cyclophosphamide" 56 (56): 28-, 1999

4 "NCCN Clinical Practice Guideline in Oncology" 1 : 2008

5 Nila Bhana, "Granulocyte colony-stimulating factors in the management of chemotherapy-induced neutropenia: evidence based review" 19 : 328-, 2007

6 김보영, "Filgrastim의 약물사용 평가" 13 (13): 126-, 1996

7 Rebecca B. Donohue, "Development of a neutropenia riskassessment tool" 3 (3): 62-, 2005

8 "American Society of Clinical OncologyL Recommendations for the use of hematopoietic colony-stimulating factors: Evidence-based, clinical practice guidelines" 12 : 2471-, 1994

9 Thomas J. Smith, "2006 update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline" 24 : 2006