Incidence and risk factors for febrile neutropenia in Japanese patients with non-Hodgkin B cell lymphoma receiving R-CHOP: 2-year experience in a single center (STOP FN in NHL 2)

Abstract

Background Myelosuppressive chemotherapy-induced febrile neutropenia (FN) is a life-threatening condition. Patients receiving granulocyte colony-stimulating factors (G-CSF) have shorter duration of neutropenia, faster recovery from fever, and shorter duration of antibiotics use. Most strategies for FN prevention using daily G-CSF and pegfilgrastim are based on overseas studies. Data on Japanese patients were lacking; thus, we previously determined the incidence of FN in non-Hodgkin B cell lymphoma (B-NHL) patients at our center. Here, we aimed to gain additional insights into pegfilgrastim use in this population. Methods This single-center, retrospective, observational study (STOP FN in NHL 2) enrolled patients with B-NHL who underwent a regimen comprising rituximab and CHOP therapy over a 2-year period (January 2015-June 2017). The incidence of FN in cycle 1 of chemotherapy, risk factors for FN development, and use of daily G-CSF and pegfilgrastim were evaluated. Results We evaluated 239 patients: 61 patients did not receive G-CSF and 178 received G-CSF. The incidence of FN was 10.5% (95% confidence interval [CI] 6.9-15.1%) in cycle 1 and 13.0% (95% CI 9.0-17.9%) in all cycles. The FN incidence was significantly lower (P = 0.0008) in patients receiving daily G-CSF and pegfilgrastim than patients not receiving G-CSF. Significant risk factors for FN were age ≥ 65 years, albumin < 3.5 g/dL, hemoglobin < 12 g/dL, and no prophylaxis with daily G-CSF/pegfilgrastim during cycle 1. Conclusions The incidence of FN in cycle 1 and in all cycles and the identified risk factors were similar with those we previously reported; thus, our results validate previous findings. Trial registration UMIN000029534.Keywords Febrile neutropenia . Incidence . Japan . Non-Hodgkin B cell lymphoma . R-CHOP . Risk factor Background Myelosuppressive chemotherapy-induced febrile neutropenia (FN) is a life-threatening condition associated with increased morbidity and mortality [1, 2] that often results in extended hospitalization and death [3]. FN may lead to unwanted chemotherapy dose reductions or may halt treatment altogether, which can compromise treatment outcomes [2].According to the current Japanese guidelines [4], all patients who present an FN incidence ≥ 20% should receive prophylaxis granulocyte colony-stimulating factor (G-CSF), regardless of the presence or absence of risk factors, in order to prevent and treat FN induced by chemotherapy [5]. Further, all patients with risk factors for FN and FN incidence of 10 to < 20% should receive prophylaxis with G-CSF [4].Findings from this study were presented as a poster presentation at the

Impact of Cell-of-Origin on Outcome of Patients With Diffuse Large B-Cell Lymphoma Treated With Uniform R-CHOP Protocol: A Single-Center Retrospective Analysis From North India

“…The incidence of grade ≥3 neutropenia and febrile neutropenia seen in our study was 13% and 9%, respectively, which is lower when compared with reported studies ( 31 ). This may be because our patient population is predominantly younger and the majority present with good risk International Prognostic Index score.…”

Risk of febrile neutropenia in very elderly patients aged ≥80 years receiving their first cycle of R‐CHOP regimen: a nationwide real‐world study in Japan

“…The proportion of very elderly patients who developed FN tended to be lower than the proportions in previous studies involving younger patients. 6,11,12 There are several possible reasons for the lower incidence of FN in the present study compared with the previous studies, despite the older age of the patients and the lower percentage of prophylactic G-CSF use. One reason may be the high proportion of patients with reduced chemotherapeutic dose in the present study.…”

“…This nationwide analysis revealed the features of FN among very elderly patients with DLBCL, which remained to be well established. The proportion of very elderly patients who developed FN tended to be lower than the proportions in previous studies involving younger patients 6,11,12 …”

Clinical Outcomes of Secondary Prophylactic Granulocyte Colony-Stimulating Factors in Breast Cancer Patients at a Risk of Neutropenia with Doxorubicin and Cyclophosphamide-Based Chemotherapy

“…A previous study has reported that pre-existing anemia may increase the risk of developing FN or severe neutropenia in patients treated with chemotherapy [28]. Lower levels of hemoglobin are associated with myelosuppression, which can further exacerbate the condition and lead to a higher incidence of FN [29]. This may explain why basal Hb < 12 g/dL increases the incidence of grade 4 neutropenia.…”