| Objective:To observe the efficacy and safty of amifostine on the malignent tumor patients who suffered with grade 3-4 neutropenia or thrombocytopenia in prior chemotherapy,and to determine the ability of amifostine to reduce hematology toxicity caused by chemotherapy.Methods:Seventy-four patients with malignent tumor(including breast cancer in 37 cases,lung cancer in 21 cases,lymphoma in 12 cases,other cancer in 5 cases)were enrolled,all participants were randomized to receive chemotherapy with or without amifostine who suffered with grade 3-4 neutropenia or thrombocytopenia in prior chemotherapy(distance into the group of no more than 2 months)in Liaoning Cancer Hospital&Institute from January 2014 to March 2015.The general data were no significant difference and comparable between experimental group and control group.Each patient in experimental group was administrated amifostine for prophylactic use in day 1,30 minutes before chemotherapy,however,patients in control group did not use amifostine.For patients with prior grade 4 neutropenia or grade 4 thrombocytopenia in experimental group and control group,they received chemotherapy with a 20%reduction.Weekly blood tests were detected after each chemotherapy cycle.The U.S.National Cancer Institute at the National Cancer Institute,NCI)common adverse events evaluation criteria(CTCAE)4.0 evaluation were according to evaluate the incidence and grade of bone marrow depression.The data were analyazed by SPSS 19 software,and Fisher exact probability method(Fisher 's exact tests)statistics were used for analysis..All tests were two-sided,and P values were a =0.05 level test..Results:1,The patients with prior grade 3 neutropenia,in experimental group with amifostine occured grade 0-2 neutropenia was 92.86%(26/28)in 26 cycles,while incidece of grade 0-2 neutropenia in control group was 64.29%(18/28)in 18 cycles.The incidence of low grade neutropenia in experimental group was significantly higher than in control group.Patients in experimental group after the prophylactic use of amifostine occured grade 3-4 neutropenia were 2 cycles,accounting for 7.14%(2/28);while patients in control group was 10 cycles,accounting for 35.71%(10/28).The incidence of high grade neutropenia in the experimental group was significantly lower than that in control group.In addition,the number of cycles in the experimental group by preventive use of amifostine and neutrophil recovery to normal in level 0 was 13,accounted for 46.43%(13/28);while the number of cycles in control group was only 1 cycle,accounted for 3.6%(1/28).The incidence of recovering to normal in experimental group was significantly higher than that in control group.P was 0.023,and there was statistical significance.2,The patients with prior grade 4 neutropenia,in experimental group by chemotherapy in 20%reduction chemotherapy plus prophylactic using of amifostine occured grade 0-2 neutropenia was 84.21%(16/19)in 16 cycles;while incidece of grade 0-2 neutropenia in control group was 73.68%(14/19)in 14 cycles,there was no significant difference between.However,patients in experimental group occured grade 0 was 47.37%(9/19)in 9 cycles,and patients in control group was 0.Patients in experimental group occured grade 3-4 neutropenia was 15.79%(3/19)in 3 cycles,patients in control group was 26.32%(5/19)in 5 cycles.P was 0.346,and there was no statistical significance.3,The patients with prior grade 3 thrombocytopenia,in experimental group by preventive use of amifostine occurred grade 0-2 thrombocytopenia was 100%(5/5)in 5 cycles;while incidece of grade 0-2 thrombocytopenia in control group was 60%(3/5)in3 cycles.The incidence of low grade thrombocytopenia in experimental group was higher than control group.Patients in experimental group after the prophylactic use of amifostine occured grade 3-4 thrombocytopenia was 0%(0/5);while patients in control group was 40%(2/10)in 2 cycles,the incidence of grade 3-4 thrombocytopenia in experimental group was lower than control group.P was 0.444,and there was no statistical significance.4,The patients with prior grade 4 thrombocytopenia,in experimental group by chemotherapy in 20%reduction plus prophylactic using of amifostine occurred grade 0-2 thrombocytopenia was 1 cycle,accounting for 20%(1/5);while 3 cycles in control group,accounting for 60%(3/5).Patients in experimental group was less than control group.Patients in experimental group by chemotherapy in 20%reduction plus prophylactic using of amifostine occurred grade 3-4 thrombocytopenia was 80%(4/5)in 4 cycles;while incidece of grade 3-4 thrombocytopenia in control group was 40%(2/5)in 2 cycles,patients in experimental group was higher than control group.P was 0.524,and there was no statistical significance.Conclusion:Patients with prior grade 3 neutropenia by chemotherapy in prophylactic using amifostine can reduce the incidence of recurring grade 3-4 neutropenia.Patients with prior grade 4 neutropenia by chemotherapy in 20%reduction chemotherapy plus prophylactic using of amifostine were shown in lower incidence of recurring grade 3-4 neutropenia thrombocytopenia,there was certain protection trend,however,there was no significantly differenece.Patients with prior grade 3 and grade 4 thrombocytopenia by chemotherapy in prophylactic using amifostine and by chemotherapy in 20%reduction chemotherapy plus prophylactic using of amifostine,the curative effect is inconclusive,remains to be explored further. |
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