Impact of febrile neutropenia on R-CHOP chemotherapy delivery and hospitalizations among patients with diffuse large B-cell lymphoma

Pettengell R, Johnsen HE, et al. Support Care Cancer 2011; [Epub ahead of print] [DOI:10.1007/s00520-011-1306-6]

http://www.ncbi.nlm.nih.gov/pubmed/22101611

 

This study aimed to describe the impact of febrile neutropenia (FN) on chemotherapy delivery and hospitalizations in adults with diffuse large B-cell lymphoma (DLBCL) receiving chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The analysis included a subgroup of patients from the IMPACT NHL international, retrospective and prospective, observational, multicentre study conducted in clinical practice. A total of 1’111 patients with DLBCL were included, of whom 409 (37%) received R-CHOP-14 and 702 (63%) received R-CHOP-21. Primary prophylactic granulocyte colony-stimulating factor (G-CSF) was given to 84% of patients receiving R-CHOP-14 and 36% of patients receiving R-CHOP-21. Secondary prophylaxis with G-CSF was administered in 14% of R-CHOP-14 patients and in 29% of R-CHOP-21 patients. Approximately 20% of patients of either chemotherapy regimen developed FN and median duration of FN was 4.0 days. Dose delays of >3 days were more frequent in patients who experienced FN than in no FN patients. Dose reductions were similar between FN and no FN patients (17% vs. 13%) in the R-CHOP-14 group but not in the R-CHOP-21 group (30% vs. 18%). RDI ≥90% was achieved by 62% of FN patients and by over 70% of no FN patients. Unplanned hospitalizations were more frequent in FN patients (80%) than in no FN patients (20%). In conclusion, in patients with DLBCL treated with R-CHOP-14 or R-CHOP-21, patients with an FN event were more likely to experience suboptimal chemotherapy delivery and unplanned hospitalization.

 

Pegfilgrastim primary prophylaxis in patients with non-Hodgkin lymphoma: results from an integrated analysis

Pettengell R, Schwenkglenks M, Bacon P, et al. Hematol Oncol 2011; [Epub ahead of print] [DOI: 10.1002/hon.982]

http://www.ncbi.nlm.nih.gov/pubmed/21246591

 

Aim of this analysis was to assess the efficacy of pegfilgrastim for preventing febrile neutropenia (FN) and related outcomes in non-Hodgkin lymphoma (NHL) patients. Studies that used standard chemotherapy regimens to treat aggressive lymphoma with a ›15% risk of FN were analysed. Most patients received a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without rituximab (272 out of 282 patients). FN was more commeon in the first cycle of chemotherapy than in any cycle, and was more frequent in elderly patients than in younger patients. Grade 4 neutropenia was also more frequent in the elderly group. Chemotherapy delivery was relatively well maintained; dose delays of ›5 days occurred in one fourth of the patients and dose reductions of ‹10% in half of the patients. Elderly patients receiving pegfilgrastim primary prophylaxis were coping with chemotherapy almost as well as younger patients.

 

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

Aapro M, Schwenkglenks M, Lyman GH, et al. Crit Rev Oncol Hematol 2010;74(3):203-10

http://www.ncbi.nlm.nih.gov/pubmed/19748281

 

This study assessed the incidence of febrile neutropenia (FN) and related complications in elderly breast cancer patients receiving pegfilgrastim primary prophylaxis (PP, 150 patients) or current practice (CP, 104 patients) neutropenia management. Eleven studies reporting commonly usred breast cancer chemotherapy regimens with moderate (15-19%) to high (›20%) FN risk were included. Approximately three out of four patients completed all cycles of planned chemotherapy in both the PP pegfilgrastim group (73%) and the CP group (75%). Only 6% of the PP pegfilgrastim group had an FN event whereas 24% experienced FN in the CP neutropenia group. The incidence of dose delays and dose reductions was also substantially lower in the PP pegfilgrastim group. Pegfilgrastim provided effective primary prophylaxis in elderly patients.

 

Hodgkin lymphoma treatment with ABVD in the US and the EU: neutropenia occurrence and impaired chemotherapy delivery

Schwenkglenks M, Pettengell R, Szucs TD, et al. J Hematol & Oncol 2010; 3:27

http://www.ncbi.nlm.nih.gov/pubmed/20723212

 

The primary objective of this study was to assess the impact of chemotherapy-induced neutropenia (CIN) on chemotherpay delivery using a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in Hodgkin lymphoma (HL) patients. Two similarly designed, prospective, observational studies from the EU and the US were combined and a total of 115 HL patients were included in the analysis. Patients receiving colony-stimulating factor (CSF) were reported more often in the US population. Dose delays (›3 days) occurred more frequently in EU patients and dose reductions (›10%) in US patients. Both the US and the EU patients had similar febrile neutropenia (FN) rates, but the incidence of CIN in cycles 1-4 was lower in US patients. CSF prophylaxis was associated with a reduced risk of grade 3 or grade 4 CIN in cycle 1. Efficient multivariate adjustment of CIN risk would need higher numbers of patients.