Pegfilgrastim Prophylaxis Is Effective in the Prevention of Febrile Neutropenia and Reduces Mortality in Patients Aged ≥ 75 Years with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Cohort Study.

Abstract

PURPOSE:

Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP).

MATERIALS AND METHODS:

We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485).

RESULTS:

Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047).

CONCLUSION:

Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

• Authors: Seong Hyun Jeong, Seok Jin Kim, Dok Hyun Yoon, Yong Park, Hye Jin Kang, Youngil Koh, Gyeong-Won Lee, Won-Sik Lee, Deok-Hwan Yang, Young Rok Do, Min Kyoung Kim, Kwai Han Yoo, Yoon Seok Choi, Hwan Jung Yun, Jun Ho Yi, Jae-Cheol Jo, Hyeon-Seok Eom, Jae-Yong Kwak, Ho-Jin Shin, Byeong Bae Park, Shin Young Hyun, Seong Yoon Yi, Ji-Hyun Kwon, Sung Yong Oh, Hyo Jung Kim, Byeong Seok Sohn, Jong Ho Won, Se-Hyung Kim, Ho-Sup Lee, Cheolwon Suh, Won Seog Kim
• Journal: Cancer research and treatment (Cancer Res Treat) Vol. 54 Issue 4 Pg. 1268-1277 (Oct 2022) ISSN: 2005-9256 [Electronic] Korea (South)
• PMID: 34990525 (Publication Type: Journal Article)

Chemical References

• Granulocyte Colony-Stimulating Factor
• pegfilgrastim
• Polyethylene Glycols
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisolone
• Filgrastim
• Prednisone

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Cyclophosphamide (adverse effects)
• Doxorubicin (adverse effects)
• Febrile Neutropenia (chemically induced, prevention & control)
• Filgrastim
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Lymphoma, Large B-Cell, Diffuse (pathology)
• Polyethylene Glycols
• Prednisolone (therapeutic use)
• Prednisone (adverse effects)
• Prospective Studies
• Rituximab (therapeutic use)
• Vincristine (therapeutic use)