G-CSF use in patients receiving first-line chemotherapy for non-Hodgkin's lymphoma (NHL) and granulocyte-colony stimulating factors (G-CSF) as observed in clinical practice in Italy.

Abstract

Treatment of non-Hodgkin lymphoma (NHL) requires chemotherapy regimens with significant risk of febrile neutropenia (FN). For patients at ≥20% FN risk, guidelines recommend primary prophylaxis (PP) with granulocyte-colony stimulating factor (G-CSF). This study assessed whether G-CSF use in NHL was in line with recommendations in routine practice. This was a retrospective, observational study of adult NHL patients receiving first-line (R)CHOP-like chemotherapy and G-CSF support between June 2010 and 2012, in Italy. The primary outcome was whether G-CSF was provided as PP, which was defined as G-CSF initiation on days 1-3 after chemotherapy, ≥3 days' use for daily G-CSFs and continued prophylaxis from cycle 1 across all cycles. Secondary prophylaxis was defined as continued prophylaxis from cycle 2 or later, and all other use was defined as Suboptimal. The analysis included 199 patients, 61% of whom had diffuse large B cell lymphoma and 21% follicular lymphoma. (R)CHOP-21 was given to 52% of patients and (R)CHOP-14 to 32%. Overall, 29% of patients received PP, while two-thirds received Suboptimal G-CSF. Of patients receiving daily G-CSF, 3% received PP and 94% received Suboptimal use; with pegfilgrastim, 65% received PP and 26% Suboptimal use. FN occurred in 13 patients (7%) and grade 3/4 neutropenia in 43%. Chemotherapy dose delays occurred in 22% and dose reductions in 18% of patients. Delivery of G-CSF, particularly daily G-CSFs, was not in accordance with guideline or product label recommendations in a large proportion of NHL patients receiving chemotherapy in Italy.

• Authors: Umberto Vitolo, Francesco Angrili, Lucy DeCosta, Sally Wetten, Massimo Federico
• Journal: Medical oncology (Northwood, London, England) (Med Oncol) Vol. 33 Issue 12 Pg. 139 (Dec 2016) ISSN: 1559-131X [Electronic] United States
• PMID: 27822615 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

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

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Cohort Studies
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage)
• Humans
• Italy
• Lymphoma, Follicular (drug therapy)
• Lymphoma, Large B-Cell, Diffuse (drug therapy)
• Male
• Middle Aged
• Neutropenia (chemically induced, prevention & control)
• Prednisone (administration & dosage)
• Retrospective Studies
• Rituximab
• Vincristine (administration & dosage)