放射線併用テモゾロミド療法によるリンパ球数減少のリスク因子の検討

概要

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Temozolomide (TMZ) and concomitant radiotherapy are often used to treat newly diagnosed glioma, followed by adjuvant therapy. TMZ causes severe lymphocytopenia, thereby increasing the risk of opportunistic infection (OI). We analyzed the risk factors of lymphocytopenia. Between October 2006 and December 2009, we examined 43 patients aged between 22 and 83 years (average age, 64 years) with primary glioblastoma (n=32), anaplastic oligoastrocytoma (n=4), anaplastic astrocytoma (n=2), anaplastic oligodendroglioma (n=2), anaplastic ependymoma (n=2), and unknown tumor (n=1). The patients received a combination of postoperative radiotherapy (5 days per week for 6 weeks; total dose, 60 Gy) and daily oral TMZ (75 mg/m2; 42 days). A total of 37 out of 43 patients completed combined radiochemotherapy. Hematologic toxicities were graded according to the Common Toxicity Criteria version 4.0: leukopenia grade 3/4, 9%; neutropenia grade 3/4, 7%; lymphopenia grade 3/4, 61%. The non-hematological toxicities observed were as follows: fatigue, 83%; nausea, 74%; and vomiting, 33%. Multivariate analysis results suggest the following lymophocytopenia risk factors: female, body weight loss, and on trimethoprim- sulfamethoxazole. These results suggest that risk factors can predict severe lymphopenia during TMZ and concomitant radiotherapy.
日本医療薬学会の論文