| Objective1.To investigate the clinical efficacy of recombinant human granulocyte colony stimulating factor(rhG-CSF) used for chemotherapy-induced bone marrow depression in gastric cancer patients when given prophylactically and therapeutically.2.To evaluate the influence of the chemotherapy delayed rate and delayed time with different treatment of rhG-CSF.3.To study the comparison of pharmaceutical economics of rhG-CSF when given prophylactically and therapeutically.MethodWith a case-control study method,45gastric cancer patients who were given DOF regimen chemotherapy from October2011to January2011in Shandong Provincial Hospital were divided into two groups, that is prophylactic group and therapeutic group. In the prophylactic group, rhG-CSF was given at the time of48hours after chemotherapy, until the count of WBC/ANC was close to the normal value; while in therapeutic group, rhG-CSF was given only when the hematological toxicity degree Ⅱ occurred (count of white blood cell below3.0×107L and/or neutrophil below1.5×109L).Until the count of WBC was above10X109/L and/or ANC above7×109L for the second consecutive, we can stop using rhG-CSF. Observe the decrease time, the minimum value and the recovery extent of WBC and ANC. Record the time of leucopenia. Pay attention to the count of hemoglobin and platelet, the chemotherapy delayed rate and delayed time, the occurring rate of febrile neutropenia(FN), the average hospitalization costs and the adverse reaction of rhG-CSF. Statistical analysis were performed using SPSS software V17.0. Comparison between two groups was performed using the chi-square test, unpaired t-test or non-parametric means test for continuous variables. A P-value of<0.05was considered statistically significant.Results1. With40evaluable cases, there were20cases in prophylactic group and20cases in therapeutic group. With12male and8female in prophylactic group, while13male and7female in therapeutic group. Before chemotherapy, the count of WBC was5.18±0.64×109L,ANC was3.16±0.52×109/L,PLT was200.3±48.3×109L and HGB was130.1±12.5g/L in the prophylactic group, compared with WBC of5.06±0.69×109L,ANC of3.07±0.51×109L,PLT of200.3±48.3×109L and HGB of124.8±12.2g/L in therapeutic group.(P>0.05)2. Take the day of chemotherapy as the first day, the count of WBC and ANC began to fall in11.05±2.23day in group B, and hematological toxicity degree Ⅱoccurred.(P<0.05).The minimum value of WBC was4.26±0.62×109/L in group A compared with2.78±0.31×109/L in group B.ANC was2.35±0.59×109/Land1.22±0.32×109/L respectively. It was considered statistically significant. The number of the days with leucopenia was0.25±0.55in group A, less than the group B which was3.10±0.31.(P<0.05)。Platelets and hemoglobin were not significantly influenced by rhG-CSF.3. To the21days, the proportion of WBC and ANC above normal value was90%and85%, respectively in group A and B. Chemotherapy delayed rate was10%and15%, respectively; Delayed time were2.51±0.71days and2.80±0.84days (P>0.05).4.The rate of FN was15%in the group B, while0%in the group A。5.The cost of rhG-CSF was1271±263.51in group A and895.6±202.3in group B. But because of the rate of FN in group B, the overall cost should also include the addition cost of monitoring project, drugs for increasing the count of WBC, treatment of FN and its complication and so on. The total cost of group A was1539.5±259.5compared with2950.5±173.2in the group B(P=0.024<0.05). 6. rhG-CSF has mild adverse reactions, higher safety and better compliance.Conclusions1. The application of rhG-CSF prophylactically can reduce the occurring rate of leucopenia, improve the decline of WBC and ANC, shorten the duration of chemotherapy-induced bone marrow depression, reduce the risk of FN and its complication.2. RhG-CSF can reduce the chemotherapy delayed rate and shorten the delayed time. The effect is equivalent when using rhG-CSF prophylactically and therapeutically.3.Preventive treatment with rhG-CSF can reduce total medical care cost to some extent, and relieve patients economic burdens. |
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