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Author: Zhaohao Cheng Yueqing City People's Hospital blood Chemotherapy doctor This article is the author's permission NMT Medical publish, please do not reprint without authorization.
Thrombocytopenia is one of the diseases frequently encountered by hematologists and oncologists, and it is also the most common cause of clinical bleeding disorders.
It is defined as a peripheral blood platelet count <100×109/L.
In the diagnosis and treatment of thrombocytopenia, thrombocytopenia drugs have always played a very important role.
Among them, rhIL-11 (recombinant human interleukin-11) is the earliest and most commonly used one on the market in China.
The National Cancer Institute Common Toxicity Standard (CTCAE-5.
0) sets the thrombocytopenia grading standard as follows [1]: In the currently available rhIL-11 instructions, the indications are mainly the following three: solid tumors, non-myeloid leukemia Treatment of grade III and IV thrombocytopenia after chemotherapy.
In the latest edition of "Chinese Expert Consensus on the Clinical Application of Recombinant Human Interleukin-11 in Prevention and Treatment of Thrombocytopenia" in 2021 [1], interleukin-11 can be used for several types of thrombocytopenia used outside the instructions, such as: CIT (Tumor Chemotherapy-induced thrombocytopenia), leukemia chemotherapy-induced thrombocytopenia, aplastic anemia, ITP (primary immune thrombocytopenia), and chemotherapy combined with radiotherapy cause CIT.
This article will explain the usage of rhIL-11 for these indications one by one.
Treatment of CIT CIT refers to the most common tumor treatment complication in which anti-tumor chemotherapy drugs inhibit bone marrow function and cause the PLT in the peripheral blood to be lower than normal.
Figure 1 Flow chart of the management of CIT with indications for treatment [1] Figure 2 Secondary prevention of CIT (pre-clinical prevention) [1] High risk factors for CIT bleeding: previous bleeding history; PLT <75×109/L before chemotherapy ; Receiving chemotherapy containing platinum, gemcitabine, cytarabine and anthracyclines; thrombocytopenia caused by tumor cell bone marrow infiltration; ECOG performance status score ≥ 2; previous radiotherapy, especially long bones and flat bones (Such as pelvis, sternum, etc.
) have received radiotherapy.
Treatment of thrombocytopenia caused by chemotherapy in acute leukemia (AL) Figure 3 Management flow chart of thrombocytopenia caused by chemotherapy in leukemia with therapeutic indications [1] Primary prevention of thrombocytopenia caused by chemotherapy in leukemia: primary prevention and secondary prevention Prevention is different.
Primary prevention is a preventive measure taken immediately after the first cycle of chemotherapy for factors that may lead to a higher risk of bleeding.
For AL patients receiving high bleeding risk chemotherapy regimens, it is recommended to use thrombopoietic drugs (interleukin-11, etc.
) prophylactically after chemotherapy.
RhIL-11, 50μg/kg, is usually administered 6-24 hours after chemotherapy, subcutaneously injected once a day for 7 to 14 days, or the drug is stopped when the inhibitory effect of chemotherapy disappears and PLT ≥ 100×109/L.
High risk factors for leukemia chemotherapy bleeding: high degree of disease malignancy; previous bleeding history; receiving high-dose cytarabine, decitabine and other drugs for chemotherapy; ECOG performance status score ≥ 2 points; co-infection.
Chemotherapy combined with radiotherapy caused CIT.
A number of clinical studies have shown that the use of interleukin-11 can significantly reduce the incidence of thrombocytopenia in tumor patients after radiotherapy and chemotherapy, increase the minimum value of platelets, shorten platelet recovery time, and do not affect the next cycle of chemotherapy.
The reaction is tolerable.
The treatment process of CIT caused by chemotherapy combined with radiotherapy refers to the above-mentioned CIT treatment process (Figure 1).
rhIL-11 is used for the treatment of ITP.
In the "Clinical Pathway Interpretation-Hematology Fascicle (2018 Edition)" compiled by the National Health Commission [2], thrombopoietic drugs (such as interleukin-11) can be used to maintain platelet counts.Figure 4 ITP treatment process [2] rhIL-11 is used in the treatment of aplastic anemia (AA) The Chinese Expert Consensus on the Diagnosis and Treatment of Aplastic Anemia (2017 Edition) formulated by the Red Blood Cell Disease (Anemia) Group of the Hematology Branch of the Chinese Medical Association )"[3], rhIL-11 is recommended for the hematopoietic treatment of AA.
Figure 5 The safety management of the choice of interleukin-11 in the treatment of severe aplastic anemia (SAA) The main adverse reactions after the clinical use of rhIL-11 include fatigue, fever, edema, tachycardia, transient anemia, and conjunctival congestion.
Most of them are mild to moderate, and they will disappear quickly after stopping the drug (as shown in the figure below) [1].
References: [1] Chinese Expert Consensus on the Clinical Application of Recombinant Interleukin-11 in the Prevention and Treatment of Thrombocytopenia (2021 Edition) [2] Clinical Pathway Interpretation-Hematology Division (2018 Edition) [3] Chinese Expert Consensus on Diagnosis and Treatment of Aplastic Anemia (2017 version) Poke "read the original text" and we will make progress together
Thrombocytopenia is one of the diseases frequently encountered by hematologists and oncologists, and it is also the most common cause of clinical bleeding disorders.
It is defined as a peripheral blood platelet count <100×109/L.
In the diagnosis and treatment of thrombocytopenia, thrombocytopenia drugs have always played a very important role.
Among them, rhIL-11 (recombinant human interleukin-11) is the earliest and most commonly used one on the market in China.
The National Cancer Institute Common Toxicity Standard (CTCAE-5.
0) sets the thrombocytopenia grading standard as follows [1]: In the currently available rhIL-11 instructions, the indications are mainly the following three: solid tumors, non-myeloid leukemia Treatment of grade III and IV thrombocytopenia after chemotherapy.
In the latest edition of "Chinese Expert Consensus on the Clinical Application of Recombinant Human Interleukin-11 in Prevention and Treatment of Thrombocytopenia" in 2021 [1], interleukin-11 can be used for several types of thrombocytopenia used outside the instructions, such as: CIT (Tumor Chemotherapy-induced thrombocytopenia), leukemia chemotherapy-induced thrombocytopenia, aplastic anemia, ITP (primary immune thrombocytopenia), and chemotherapy combined with radiotherapy cause CIT.
This article will explain the usage of rhIL-11 for these indications one by one.
Treatment of CIT CIT refers to the most common tumor treatment complication in which anti-tumor chemotherapy drugs inhibit bone marrow function and cause the PLT in the peripheral blood to be lower than normal.
Figure 1 Flow chart of the management of CIT with indications for treatment [1] Figure 2 Secondary prevention of CIT (pre-clinical prevention) [1] High risk factors for CIT bleeding: previous bleeding history; PLT <75×109/L before chemotherapy ; Receiving chemotherapy containing platinum, gemcitabine, cytarabine and anthracyclines; thrombocytopenia caused by tumor cell bone marrow infiltration; ECOG performance status score ≥ 2; previous radiotherapy, especially long bones and flat bones (Such as pelvis, sternum, etc.
) have received radiotherapy.
Treatment of thrombocytopenia caused by chemotherapy in acute leukemia (AL) Figure 3 Management flow chart of thrombocytopenia caused by chemotherapy in leukemia with therapeutic indications [1] Primary prevention of thrombocytopenia caused by chemotherapy in leukemia: primary prevention and secondary prevention Prevention is different.
Primary prevention is a preventive measure taken immediately after the first cycle of chemotherapy for factors that may lead to a higher risk of bleeding.
For AL patients receiving high bleeding risk chemotherapy regimens, it is recommended to use thrombopoietic drugs (interleukin-11, etc.
) prophylactically after chemotherapy.
RhIL-11, 50μg/kg, is usually administered 6-24 hours after chemotherapy, subcutaneously injected once a day for 7 to 14 days, or the drug is stopped when the inhibitory effect of chemotherapy disappears and PLT ≥ 100×109/L.
High risk factors for leukemia chemotherapy bleeding: high degree of disease malignancy; previous bleeding history; receiving high-dose cytarabine, decitabine and other drugs for chemotherapy; ECOG performance status score ≥ 2 points; co-infection.
Chemotherapy combined with radiotherapy caused CIT.
A number of clinical studies have shown that the use of interleukin-11 can significantly reduce the incidence of thrombocytopenia in tumor patients after radiotherapy and chemotherapy, increase the minimum value of platelets, shorten platelet recovery time, and do not affect the next cycle of chemotherapy.
The reaction is tolerable.
The treatment process of CIT caused by chemotherapy combined with radiotherapy refers to the above-mentioned CIT treatment process (Figure 1).
rhIL-11 is used for the treatment of ITP.
In the "Clinical Pathway Interpretation-Hematology Fascicle (2018 Edition)" compiled by the National Health Commission [2], thrombopoietic drugs (such as interleukin-11) can be used to maintain platelet counts.Figure 4 ITP treatment process [2] rhIL-11 is used in the treatment of aplastic anemia (AA) The Chinese Expert Consensus on the Diagnosis and Treatment of Aplastic Anemia (2017 Edition) formulated by the Red Blood Cell Disease (Anemia) Group of the Hematology Branch of the Chinese Medical Association )"[3], rhIL-11 is recommended for the hematopoietic treatment of AA.
Figure 5 The safety management of the choice of interleukin-11 in the treatment of severe aplastic anemia (SAA) The main adverse reactions after the clinical use of rhIL-11 include fatigue, fever, edema, tachycardia, transient anemia, and conjunctival congestion.
Most of them are mild to moderate, and they will disappear quickly after stopping the drug (as shown in the figure below) [1].
References: [1] Chinese Expert Consensus on the Clinical Application of Recombinant Interleukin-11 in the Prevention and Treatment of Thrombocytopenia (2021 Edition) [2] Clinical Pathway Interpretation-Hematology Division (2018 Edition) [3] Chinese Expert Consensus on Diagnosis and Treatment of Aplastic Anemia (2017 version) Poke "read the original text" and we will make progress together
