ネダプラチン・5-FU併用療法における好中球減少・血小板減少の危険因子解析

抄録

Patients administered nedaplatin (NDP) and 5-fluorouracil (5-FU) frequently develop severe myelosuppression such as thrombocytopenia and neutropenia. However, predictive factors for thrombocytopenia and neutropenia in patients treated with NDP and 5-FU therapy remain unknown. We conducted a retrospective study. One hundred and fifty-seven cancer patients were initially administered NDP and 5-FU at Nagasaki University Hospital. A multiple logistic regression analysis was performed to identify risk factors for Grade 3-4 neutropenia and thrombocytopenia. The incidence of Grade 3-4 neutropenia and thrombocytopenia was 72.0％ and 43.9％, respectively. The results of the multivariate analysis showed that significant predictors of Grade 3-4 neutropenia were associated with high-dose NDP (> 100 mg/m²) (odds ratio (OR) 6.56, 95％ confidence interval (CI) 2.70 - 17.58, P < 0.001), low neutrophil counts measured just before the treatment (low baseline neutrophil count) (< 4.7 × 10³/μL) (OR 2.53, 95％ CI 1.04 - 6.29, P = 0.041) and low creatinine clearance values at the start of the treatment (low baseline CCr) (< 56.5 mL/min) (OR 3.64, 95％ CI 1.41 - 10.44, P = 0.007). The incidences of Grade 3-4 thrombocytopenia were high-dose NDP (> 100 mg/m²) (OR 4.48, 95％ CI 2.02 - 9.93, P < 0.001) and low baseline CCr (< 61.6 mL/min) (OR 4.49, 95％ CI 2.02 - 9.77, P < 0.001). Platelet and/or neutrophil reductions need to be considered when CCr is low, and neutrophil reductions when the neutrophil count is low as the initial conditions of patients at the time of the administration of NDP and 5-FU therapy.