Colony stimulating factors for chemotherapy induced febrile neutropenia

  • Review
  • Intervention

Authors


Abstract

Background

Febrile neutropenia is a frequent event for cancer patients undergoing chemotherapy and it is potentially a life threatening situation. The current treatment is supportive care plus antibiotics. Colony stimulating factors (CSF) are cytokines that stimulate and accelerate the production of one or more cellular lines in bone marrow. Some clinical trials addressed the question of whether the addition of CSF to antibiotics (ATB) could improve the outcomes of patients with febrile neutropenia. The results of these trials are conflicting and no definitive conclusion could be reached.

Objectives

To evaluate the safety and effectiveness of adding colony stimulating factors to ATB when treating febrile neutropenia caused by cancer chemotherapy.

Search methods

The search covered the major electronic databases: CANCERLIT, EMBASE, LILACS, MEDLINE, SCI and The Cochrane Controlled Trials Register. Experts were consulted and references from the relevant articles scanned.

Selection criteria

We looked for all randomized controlled trials (RCTs) that compare CSF plus antibiotics versus antibiotics alone for the treatment of established febrile neutropenia in adults and children.

Data collection and analysis

Two of the reviewers independently selected, critically appraised and extracted data from the studies. A meta-analysis of the select studies was performed, using Review Manager .

Main results

More than 8000 references were screened. Thirteen studies were included. The overall mortality was not influenced by the use of CSF [Odds Ratio (OR) = 0.68; 95% Confidence Interval (CI) = 0.43 to 1.08; p=0.1]. A marginally significant result was obtained for the use of CSF in reducing infection related mortality [OR= 0.51; 95% CI = 0.26 to 1.00; p=0.05], but this result was highly influenced by one study. When this study is excluded from our analysis, this possible benefit disappears [OR= 0.85; 95% CI = 0.33 to 2.20; p= 0.7]. The group of patients treated with CSF had a shorter length of hospitalization [Hazard Ratio (HR) = 0.63; 95% CI = 0.49 to 0.82; p=0.0006] and a shorter time to neutrophil recovery [HR= 0.32; 95% CI = 0.23 to 0.46; p < 0.00001].

Authors' conclusions

The use of CSF in patients with febrile neutropenia due to cancer chemotherapy does not affect overall mortality, but reduces the amount of time spent in hospital and the neutrophil recovery period. It was not clear whether CSF has an effect on infection-related mortality.

摘要

背景

用於治療化療誘發性發熱性嗜中性球減少症之聚落刺激因子

發熱性嗜中性球減少症常見於化療癌症病患,且其為一種潛在致命性的狀況。目前之治療為支持性之照護加上抗生素。聚落刺激因子 (colony stimulating factors;CSF) 是可刺激並加速骨髓中一或多種細胞系生成之細胞激素。部分之臨床試驗係關於在抗生素 (ATB) 外添加CSF是否可改善發熱性嗜中性球減少症病患之結果。此等試驗之結果具有諸多矛盾,且因此無法達成決定性之結論。

目標

評估在治療由癌症化療所引起之發熱性嗜中性球減少症時,於ATB中添加聚落刺激因子的安全性及有效性。

搜尋策略

搜尋涵蓋主要之電子資料庫:CANCERLIT、EMBASE、LILACS、MEDLINE、SCI以及Cochrane Controlled Trials Register。亦諮詢專家並審閱相關文章之參考文獻。

選擇標準

我們尋找比較CSF加抗生素對單獨使用抗生素對於治療成人及兒童之確診發熱性嗜中性球減少症的所有隨機對照試驗 (RCTs) 。

資料收集與分析

由其中2名回顧作者獨立選擇、進行批評性評價、並自研究中摘錄數據。亦使用Review Manager對所選研究進行整合分析。

主要結論

共審閱超過8000份參考文獻。其中收錄13項研究。其整體死亡率並未因為CSF之使用而受到影響[勝算比 (OR) = 0.68; 95% 信賴區間 (CI) = 0.43 to 1.08; p = 0.1]。CSF之使用對於降低感染相關性死亡率而言具有邊緣顯著性之結果[OR = 0.51; 95% CI = 0.26 to 1.00; p = 0.05],但此一結果受到其中1項研究之高度影響。在將此一研究由分析中排除時,此種可能之效益即會消失[OR = 0.85; 95% CI = 0.33 to 2.20; p = 0.7]。以CSF治療之病患組具有較短之入院期間[風險比 (HR) = 0.63; 95% CI = 0.49 to 0.82; p = 0.0006]以及較短之嗜中性球恢復時間[HR = 0.32; 95% CI = 0.23 to 0.46; p <0.00001]。

作者結論

對於因癌症化療而產生發熱性嗜中性球減少症之病患使用CSF並不會影響整體死亡率,但是其可減少入院之時間及嗜中性球恢復時間。仍不清楚CSF是否會對感染相關性死亡率具有作用。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

針對化療引起之發熱性嗜中性球減少症而給予聚落刺激因子可減少病患入院之時間。發熱性嗜中性球減少症常見於接受化療之病患。其可具有致命性。由13項隨機對照試驗所取得之證據顯示,聚落刺激因子 (CSF) 似乎無法影響死亡率,但是確可縮短病患入院之時間,並加速白血球之恢復。仍不清楚CSF是否會對感染相關死亡率具有作用。個別病患之資料分析應可對該作用提供較清楚之解答。

Plain language summary

Colony Stimulating Factors administered for chemotherapy-induced febrile neutropenia reduce time patients spend in hospital

Febrile neutropenia frequently occurs in patients undergoing chemotherapy. It can be life threatening. Evidence from 13 randomized controlled trials shows Colony Stimulating Factors (CSF) do not appear to affect the death-rate, but do shorten the amount of time a patient spends in hospital, and hasten the recovery of the white blood cells. It is not clear if CSF has an effect on infection-related mortality. An individual patient data analysis would give a clearer picture of the effect.

Ancillary