Fatores estimuladores de colonias para o tratamento da neurotropenia febril pos-quimioterapia : revisão sistematica da literatura e meta-analise

AUTOR(ES)
DATA DE PUBLICAÇÃO

2003

RESUMO

Colony Stimulating Factors for the Treatment of Febrile Neutropenia BACKGROUND: Febrile Neutropenia is a frequent event in cancer patients treated with chemotherapy. It is a potentially life threatening situation and requires prompt medical intervention. The standard treatment includes supportive care plus broad-spectrum antibiotics (ATB). Due to the known effect of some cytokines (colony stimulating factors CSF) on increase the numbers of circulating neutrophils, clinical studies have been done to evaluate their role on the treatment of febrile neutropenia. The results of these studies are, indeed, controversial. A systematic review is highly recommended to evaluate the role of CSF on the treatment of febrile neutropenia. METHODS: A systematic review of randomized controlled trials that compare the use of CSF plus ATB versus ATB alone on the treatment of febrile neutropenia. When appropriate, the results of individual studies were pooled on a meta-analysis. The pooled results are expressed as Peto s Odds Ratio (OR) and Hazard Ratio (HR) with the correspondent 95% confidence interval (CI). The outcomes evaluated are mortality (overall and infection related), time of hospitalization, time to neutrophil recover, time to defervecence time to withdrawals of antibiotics and side effects. RESULTS: more than 9000 references were screened. 13 studies were included. The overall mortality was not influenced by the use of CSF [OR= 0.68; CI95%= 0.43 to 1.08; p=O.I]. A significant result was obtained to the use of CSF on reducing infection related mortality [OR= 0.51; CI95% = 0.26 to 1.00 ;p=0.05], but this result was highly influenced by one study. When this study is excluded from our ana1ysis, this possible result disappears [OR= 0.85; CI95% = 0.33 to 2.20; p 0.7]. The group treated with CSF had a shorter time of hospitalization [HR= 0.63; CI 95%= 0.49 a 0.82; p=0.0006] and a shorter time to neutrophil recovering [HR= 0.32; CI 95%= 0.23 a 0.46; p <0.00001]. CONCLUSION: The present data do not support a role of CSF on reducing mortality of patients with febrile neutropenia, but they have a positive influence on the time of hospitalization

ASSUNTO(S)

infecção cancer

ACESSO AO ARTIGO

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