Neutropenie – wann ist eine GCSF Unterstützung notwendig?

Zusammenfassung

Viele Systemtherapien, die in der Behandlung uroonkologischer Erkrankungen eingesetzt werden, verursachen Störungen der Hämatopoese. Dadurch kann es zum Auftreten einer Neutropenie kommen. Neutropene Patienten sind gegenüber bakteriellen, aber auch anderen Infektionen anfällig, häufig ist Fieber bei diesen Patienten das einzige Symptom. Eine solches neutropenes Fieber bedeutet in aller Regel nicht nur eine lebensbedrohliche Therapiekomplikation mit einer oft deutlichen Einschränkung der Lebensqualität der Patienten, sondern kann durch Therapieverzögerungen oder erforderliche Dosismodifikationen auch die Prognose verschlechtert. Granulozyten-Kolonie-stimulierende Faktoren (GCSF), die eine vermehrte Bildung von neutrophilen Granulozyten stimulieren, können sowohl zur unterstützenden Behandlung bei der febrilen Neutropenie als auch zu deren Prophylaxe eingesetzt werden. Dabei ist die korrekte Indikationsstellung für eine solche GCSF-Unterstützung sowohl vom generellen Risiko einer febrilen Neutropenie, der jeweils eingesetzten Therapie, als auch von individuellen Patientenfaktoren und dem Therapieziel (palliative vs. kurative Therapie) abhängig. Basierend auf den aktuellen Empfehlungen der deutschen sowie internationalen Leitlinien möchte dieser Beitrag einen aktuellen und praxisorientierten Überblick zum Einsatz von GCSF in der Uroonkologie geben.

Abstract

Many systemic treatments used in genitourinary oncology negatively affect haematopoiesis, thus leading to neutropenia. Neutropenic patients are vulnerable to bacterial, and other infections. Often fever is the only symptom in these patients. Neutropenic fever is a major threat for these patients, as it may lead to life-threatening therapy complications that significantly impair the patient’s quality of life, Moreover, it may also worsen the prognosis due to therapy delays or necessary dose modifications. Granulocyte colony stimulating factors (GCSF), which can improve neutrophil granulocyte formation, are used both for supportive treatment in febrile neutropenia and for its prophylaxis. The correct indication for such GCSF support depends on the general risk of febrile neutropenia of the therapy used, as well as on individual patient factors and the treatment intent (palliative vs. curative). Based on the current recommendations both of the German and international guidelines, this article aims to provide an up-to-date and practice-oriented overview of the use of GCSF in uro-oncology.

Schlüsselwörter

Neutropenie - Chemotherapie - Supportivtherapie - Granulozyten-Kolonie-stimulierende Faktoren

Keywords

neutropenia - chemotherapy - supportive care - granulocyte-colony-stimulating factors

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