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Lymphocytic disease is currently one of the most vigorous fields in hematology at home and abroad.
In recent years, remarkable achievements have been made in the pathogenesis of the disease to targeted and immunotherapy.
In order to promote exchanges between domestic and international peers, the First National Lymphocytic Disease Academic Conference of the Chinese Medical Association and the 2021 International Lymphoma Update Symposium will be held in Chengdu, Sichuan Province from April 16-18, 2021.
At this conference, Professor Peng Jun from Qilu Hospital of Shandong University gave a theme report on "How to Diagnose and Treat Tumor Chemotherapy-Related Thrombocytopenia".
Yimaitong organized the main content as follows.
Tumor chemotherapy-related thrombocytopenia diagnosis Tumor chemotherapy-induced thrombocytopenia (CIT) refers to the inhibitory effect of anti-tumor chemotherapy drugs on nuclear cells, resulting in insufficient platelet production or increased destruction, resulting in peripheral blood platelets <100×109/L.
Different chemotherapeutic drugs cause CIT in different mechanisms, which act on different links of platelet production and apoptosis.
For example, busulfan affects pluripotent stem cells; cyclophosphamide affects megakaryocyte progenitor cells; bortezomib affects mature megakaryocytes by inhibiting NFκB Produce platelets; ABT-737 and etoposide can reduce the expression of apoptotic protein Bcl-x (L) and accelerate platelet apoptosis.
CIT usually appears 3-4 days after chemotherapy and recovers after 2-4 weeks.
The speed and extent of the reduction of platelet levels are related to the type, dosage, combination medication and the number of chemotherapy and individual differences.
The cumulative dose of chemotherapeutic drugs can lead to the emergence of CIT from scratch to severe, and even cause CIT to be irreversible.
When the platelet level is less than 50×109/L, CIT can cause skin or mucous membrane bleeding, and the patient has certain risks in undergoing surgery and traumatic examinations; when the platelet level is less than 20×109/L, CIT can cause high risk Spontaneous bleeding; when the platelet level is less than 10×109/L, CIT can cause spontaneous bleeding with a very high risk.
CIT will delay the time of chemotherapy, affect the dose of chemotherapy, and reduce the survival rate of cancer patients.
A retrospective study involving 341 CIT patients showed that 65.
4% of CIT patients delayed chemotherapy, and 15% of CIT patients reduced the dose of chemotherapy during the treatment cycle due to thrombocytopenia.
A reduction of ≥15% in chemotherapy dose was significantly associated with survival.
Professor Peng Jun then introduced the diagnostic criteria of CIT.
The diagnostic criteria for CIT include: peripheral blood platelets <100×109/L; certain chemotherapy drugs that can cause thrombocytopenia should be applied exactly before the onset, and thrombocytopenia gradually reduced or platelets returned to normal after stopping the drug; re-use the chemotherapy Thrombocytopenia reappeared after medication; other causes of thrombocytopenia were ruled out, such as aplastic anemia, acute leukemia, radiation sickness, immune thrombocytopenic purpura and hypersplenism, etc.
; it can also cause thrombocytopenia if it is excluded Non-chemotherapeutic drugs such as sulfa drugs or molecular targeted drugs; avoid pseudothrombocytopenia caused by ethylenediaminetetraacetic acid (EDTA) as the test sample anticoagulant; patients with or without bleeding tendency, such as There are petechiae, purpura or unexplained nose bleeding on the skin, and even more serious signs of internal organ bleeding.
Treatment of tumor chemotherapy-related thrombocytopenia The overall treatment goal of CIT is to reduce the risk of bleeding, ensure that chemotherapy is carried out on time and in sufficient quantities, to ensure efficacy and improve the quality of life of patients.
Specific treatment goals include avoiding the lowest platelet level of patients <50×109/L, while avoiding platelet transfusion, bleeding events, chemotherapy delays, and chemotherapy dose reduction.
The principle of CIT treatment depends on whether the patient is bleeding or not.
Professor Peng Jun said that for patients who have bleeding, platelets and platelet-promoting growth factors need to be transfused; for patients who have not yet bleeding, it is necessary to determine preventive platelet transfusion and platelet transfusion based on the patient’s platelet level.
Promote platelet growth factor or observe closely.
The current treatment options for CIT are platelet transfusion or platelet-promoting growth factor.
Platelet transfusion is one of the fastest and most effective treatments for severe thrombocytopenia.
However, Professor Peng Jun also pointed out that platelet transfusion has the risk of infectious diseases, platelet transfusion-related complications, platelet antibodies leading to ineffective platelet transfusion or immune response after transfusion.
Therefore, under the premise of standardizing platelet transfusion, it is necessary to use platelet growth factors to reduce the problems caused by platelet transfusion.
Platelet growth factors currently in clinical use include recombinant human interleukin 11 (rhIL-11) or derivatives, recombinant human thrombopoietin (rhTPO), and TPO receptor agonists.
rhTPO is suitable for patients with CIT level II or higher in the previous chemotherapy cycle or with a greater risk of bleeding, and is given secondary prevention.
Professor Peng Jun pointed out that in the early stage of rhTPO medication, blood routine should be closely monitored.
When the patient's platelets rise sharply, attention should be paid to prevent thrombosis; when using TPO receptor agonists, it is necessary to avoid simultaneous use of multivalent cation preparations, acid inhibitors, milk, and mineral supplements.
In the early stage of medication, blood routine testing is also required to prevent thrombosis.
At the same time, the patient’s liver function needs to be tested during use, and attention should be paid to the risk of cataracts in patients.
For rhIL-11 and its derivatives, Professor Jun Peng pointed out that the patient's body weight should be monitored during use, and attention should be paid to water and sodium retention.
For patients with impaired renal function, the dosage should be reduced.
Since the incidence of atrial fibrillation caused by rhIL-11 and its derivatives is age-dependent, it should be used with caution in elderly patients, especially those with a history of heart disease.
Professor Peng Jun then introduced the results of related studies on platelet-promoting growth factors and compared the effects of different platelet-promoting growth factors.
A randomized controlled study was conducted in China to compare the efficacy of rhTPO and rhIL-11 in preventing CIT in non-small cell lung cancer.
The results of the study showed that rhIL-11 and rhTPO had no significant difference in the number of days that the platelet levels of patients recovered to 75×109/L.
In the study, the platelet levels of the two groups of patients were less than 50×109/L in days, platelet increments, and adverse events.
Significant differences.
In addition, the results of a retrospective study conducted by the Cancer Hospital of Fudan University showed that there was no significant difference in the platelet level recovery time and platelet recovery rate of patients receiving rhIL-11 and rhTPO treatment.
There are also studies exploring the efficacy of the combined regimen of rhIL-11 and rhTPO.
The results of the study show that the combined regimen of rhIL-11 and rhTPO reduces the number of days of continuous medication and reduces platelets compared to rhIL-11 or rhTPO alone.
Reduce the incidence of symptoms and reduce the patient's need for platelet transfusion.
Professor Peng Jun, Doctor of Medicine, Chief Physician, PhD Supervisor, Executive Deputy Director of the Department of Hematology, Qilu Hospital of Shandong University, "Changjiang Scholar" Distinguished Professor, National Outstanding Youth Science Foundation Winner, National Outstanding Doctoral Dissertation Award Winner, Chinese Society of Experimental Hematology, Vice Chairman, China Member of the Hematology Physiology Committee of the Physiological Society Member of the Thrombosis and Hemostasis Professional Group of the Hematology Branch of the Chinese Medical Association Stamp "Read the original", we will make progress together
In recent years, remarkable achievements have been made in the pathogenesis of the disease to targeted and immunotherapy.
In order to promote exchanges between domestic and international peers, the First National Lymphocytic Disease Academic Conference of the Chinese Medical Association and the 2021 International Lymphoma Update Symposium will be held in Chengdu, Sichuan Province from April 16-18, 2021.
At this conference, Professor Peng Jun from Qilu Hospital of Shandong University gave a theme report on "How to Diagnose and Treat Tumor Chemotherapy-Related Thrombocytopenia".
Yimaitong organized the main content as follows.
Tumor chemotherapy-related thrombocytopenia diagnosis Tumor chemotherapy-induced thrombocytopenia (CIT) refers to the inhibitory effect of anti-tumor chemotherapy drugs on nuclear cells, resulting in insufficient platelet production or increased destruction, resulting in peripheral blood platelets <100×109/L.
Different chemotherapeutic drugs cause CIT in different mechanisms, which act on different links of platelet production and apoptosis.
For example, busulfan affects pluripotent stem cells; cyclophosphamide affects megakaryocyte progenitor cells; bortezomib affects mature megakaryocytes by inhibiting NFκB Produce platelets; ABT-737 and etoposide can reduce the expression of apoptotic protein Bcl-x (L) and accelerate platelet apoptosis.
CIT usually appears 3-4 days after chemotherapy and recovers after 2-4 weeks.
The speed and extent of the reduction of platelet levels are related to the type, dosage, combination medication and the number of chemotherapy and individual differences.
The cumulative dose of chemotherapeutic drugs can lead to the emergence of CIT from scratch to severe, and even cause CIT to be irreversible.
When the platelet level is less than 50×109/L, CIT can cause skin or mucous membrane bleeding, and the patient has certain risks in undergoing surgery and traumatic examinations; when the platelet level is less than 20×109/L, CIT can cause high risk Spontaneous bleeding; when the platelet level is less than 10×109/L, CIT can cause spontaneous bleeding with a very high risk.
CIT will delay the time of chemotherapy, affect the dose of chemotherapy, and reduce the survival rate of cancer patients.
A retrospective study involving 341 CIT patients showed that 65.
4% of CIT patients delayed chemotherapy, and 15% of CIT patients reduced the dose of chemotherapy during the treatment cycle due to thrombocytopenia.
A reduction of ≥15% in chemotherapy dose was significantly associated with survival.
Professor Peng Jun then introduced the diagnostic criteria of CIT.
The diagnostic criteria for CIT include: peripheral blood platelets <100×109/L; certain chemotherapy drugs that can cause thrombocytopenia should be applied exactly before the onset, and thrombocytopenia gradually reduced or platelets returned to normal after stopping the drug; re-use the chemotherapy Thrombocytopenia reappeared after medication; other causes of thrombocytopenia were ruled out, such as aplastic anemia, acute leukemia, radiation sickness, immune thrombocytopenic purpura and hypersplenism, etc.
; it can also cause thrombocytopenia if it is excluded Non-chemotherapeutic drugs such as sulfa drugs or molecular targeted drugs; avoid pseudothrombocytopenia caused by ethylenediaminetetraacetic acid (EDTA) as the test sample anticoagulant; patients with or without bleeding tendency, such as There are petechiae, purpura or unexplained nose bleeding on the skin, and even more serious signs of internal organ bleeding.
Treatment of tumor chemotherapy-related thrombocytopenia The overall treatment goal of CIT is to reduce the risk of bleeding, ensure that chemotherapy is carried out on time and in sufficient quantities, to ensure efficacy and improve the quality of life of patients.
Specific treatment goals include avoiding the lowest platelet level of patients <50×109/L, while avoiding platelet transfusion, bleeding events, chemotherapy delays, and chemotherapy dose reduction.
The principle of CIT treatment depends on whether the patient is bleeding or not.
Professor Peng Jun said that for patients who have bleeding, platelets and platelet-promoting growth factors need to be transfused; for patients who have not yet bleeding, it is necessary to determine preventive platelet transfusion and platelet transfusion based on the patient’s platelet level.
Promote platelet growth factor or observe closely.
The current treatment options for CIT are platelet transfusion or platelet-promoting growth factor.
Platelet transfusion is one of the fastest and most effective treatments for severe thrombocytopenia.
However, Professor Peng Jun also pointed out that platelet transfusion has the risk of infectious diseases, platelet transfusion-related complications, platelet antibodies leading to ineffective platelet transfusion or immune response after transfusion.
Therefore, under the premise of standardizing platelet transfusion, it is necessary to use platelet growth factors to reduce the problems caused by platelet transfusion.
Platelet growth factors currently in clinical use include recombinant human interleukin 11 (rhIL-11) or derivatives, recombinant human thrombopoietin (rhTPO), and TPO receptor agonists.
rhTPO is suitable for patients with CIT level II or higher in the previous chemotherapy cycle or with a greater risk of bleeding, and is given secondary prevention.
Professor Peng Jun pointed out that in the early stage of rhTPO medication, blood routine should be closely monitored.
When the patient's platelets rise sharply, attention should be paid to prevent thrombosis; when using TPO receptor agonists, it is necessary to avoid simultaneous use of multivalent cation preparations, acid inhibitors, milk, and mineral supplements.
In the early stage of medication, blood routine testing is also required to prevent thrombosis.
At the same time, the patient’s liver function needs to be tested during use, and attention should be paid to the risk of cataracts in patients.
For rhIL-11 and its derivatives, Professor Jun Peng pointed out that the patient's body weight should be monitored during use, and attention should be paid to water and sodium retention.
For patients with impaired renal function, the dosage should be reduced.
Since the incidence of atrial fibrillation caused by rhIL-11 and its derivatives is age-dependent, it should be used with caution in elderly patients, especially those with a history of heart disease.
Professor Peng Jun then introduced the results of related studies on platelet-promoting growth factors and compared the effects of different platelet-promoting growth factors.
A randomized controlled study was conducted in China to compare the efficacy of rhTPO and rhIL-11 in preventing CIT in non-small cell lung cancer.
The results of the study showed that rhIL-11 and rhTPO had no significant difference in the number of days that the platelet levels of patients recovered to 75×109/L.
In the study, the platelet levels of the two groups of patients were less than 50×109/L in days, platelet increments, and adverse events.
Significant differences.
In addition, the results of a retrospective study conducted by the Cancer Hospital of Fudan University showed that there was no significant difference in the platelet level recovery time and platelet recovery rate of patients receiving rhIL-11 and rhTPO treatment.
There are also studies exploring the efficacy of the combined regimen of rhIL-11 and rhTPO.
The results of the study show that the combined regimen of rhIL-11 and rhTPO reduces the number of days of continuous medication and reduces platelets compared to rhIL-11 or rhTPO alone.
Reduce the incidence of symptoms and reduce the patient's need for platelet transfusion.
Professor Peng Jun, Doctor of Medicine, Chief Physician, PhD Supervisor, Executive Deputy Director of the Department of Hematology, Qilu Hospital of Shandong University, "Changjiang Scholar" Distinguished Professor, National Outstanding Youth Science Foundation Winner, National Outstanding Doctoral Dissertation Award Winner, Chinese Society of Experimental Hematology, Vice Chairman, China Member of the Hematology Physiology Committee of the Physiological Society Member of the Thrombosis and Hemostasis Professional Group of the Hematology Branch of the Chinese Medical Association Stamp "Read the original", we will make progress together
