Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients

Ise, Masataka; Matsuda, Kensuke; Shimura, Arika; Masamoto, Yosuke; Kurokawa, Mineo

doi:10.1007/s12185-021-03118-6

Cited by 3 publications

(4 citation statements)

References 26 publications

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Section: A C C E P T E D a R T I C L Ementioning

confidence: 83%

“…However, it is likely that ARDI could be increased by pegfilgrastim prophylaxis. This assumption is supported by a recent analysis from Japan, where pegfilgrastim prophylaxis improved dose delivery in elderly patients [24]. Given that reduced dose intensities have been associated with poor outcomes in most studies [27,28], maintaining dose intensity with pegfilgrastim prophylaxis may improve overall treatment outcomes.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 86%

“…The prophylactic effect of pegfilgrastim has not been fully evaluated throughout the cycles of standard R-CHOP in DLBCL patients as previous studies included heterogeneous disease groups (NHLs), diverse regimens (CHOP, R-CHOP, and others), use of pegfilgrastim only in the first cycle, or mixed use of G-CSF or pegfilgrastim [9,10,[22][23][24]. In real-world practice, primary prophylaxis is not fully performed [13].…”

Section: Discussionmentioning

confidence: 99%

“…Based on the findings of this study and previous studies, the benefits of pegfilgrastim primary prophylaxis can be summarized as follows: (1) it reduces the incidence of FN and need for hospitalization [ 17 , 23 , 25 ]; (2) it provides better dose delivery [ 24 , 25 ]; (3) it is convenient as only a single injection is required and is more cost-effective compared to secondary prophylaxis, daily use of G-CSF, or treatment of FN [ 4 , 23 , 30 ]; and (4) it is associated with fewer infection-related deaths and better survival outcomes, especially in elderly DLBCL patients. Although OS benefit was not observed in the entire group, the current study supports more active use of pegfilgrastim prophylaxis in DLBCL patients treated with R-CHOP.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2022

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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 methodsWe 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). ResultsSince 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). ConclusionPegfilgrastim 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.

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