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

Abstract

PURPOSE:

This analysis from an observational study of clinical practice describes the impact of febrile neutropenia (FN) on chemotherapy delivery and hospitalizations.

METHODS:

Adults with diffuse large B-cell lymphoma (DLBCL) scheduled to receive ≥ 3 cycles of 2- or 3-weekly CHOP with rituximab (R-CHOP-14/21) were eligible. Primary outcome was incidence of FN.

RESULTS:

FN data were available for 409 patients receiving R-CHOP-14 and 702 patients receiving R-CHOP-21. FN incidence was R-CHOP-14, 20% (81/409) and R-CHOP-21, 19% (133/702). Rates of primary prophylaxis with granulocyte-colony stimulating factor were R-CHOP-14, 84% (345/409) and R-CHOP-21, 36% (252/702). A large number of patients experienced their first FN episode in cycle 1 (R-CHOP-14, 24/81 [30%]; R-CHOP-21, 63/133 [47%]). Multiple risk factors (≥ 2) for FN were more frequent in patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 60/81 [74%] versus 179/328 [55%]; R-CHOP-21, 98/133 [74%] versus 339/569 [60%]). A similar trend was observed for unplanned hospitalizations (R-CHOP-14, 63/81 [78%] versus 68/328 [21%]; R-CHOP-21, 105/133 [79%] versus 100/569 [18%]). Achievement of chemotherapy relative dose intensity ≥ 90% was lower among patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 30/81 [37%] versus 234/328 [71%]; R-CHOP-21, 83/133 [62%] versus 434/569 [76%]).

CONCLUSIONS:

In patients with DLBCL treated with R-CHOP-14 or R-CHOP-21, patients with an event of FN were more likely to experience suboptimal chemotherapy delivery and increased incidence of unplanned hospitalizations than those without FN. FN-related hospitalizations are likely to impact chemotherapy delivery and to incur substantial costs.

• Authors: Ruth Pettengell, Hans E Johnsen, Hans E Johnson, Pieternella J Lugtenburg, Antonio Salar Silvestre, Ulrich Dührsen, Francesca G Rossi, Matthias Schwenkglenks, Kate Bendall, Zsolt Szabo, Ulrich Jaeger
• Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Support Care Cancer) Vol. 20 Issue 3 Pg. 647-52 (Mar 2012) ISSN: 1433-7339 [Electronic] Germany
• PMID: 22101611 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• R-CHOP protocol
• Granulocyte Colony-Stimulating Factor
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Comorbidity
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Female
• Fever (epidemiology)
• Granulocyte Colony-Stimulating Factor (administration & dosage)
• Hospitalization (statistics & numerical data)
• Humans
• Incidence
• Lymphoma, Large B-Cell, Diffuse (drug therapy, epidemiology)
• Male
• Middle Aged
• Neutropenia (epidemiology)
• Prednisone (administration & dosage)
• Prospective Studies
• Retrospective Studies
• Rituximab
• Vincristine (administration & dosage)