J Korean Med Sci.  2014 Nov;29(11):1493-1500. 10.3346/jkms.2014.29.11.1493.

Patterns of Neutropenia and Risk Factors for Febrile Neutropenia of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP

Affiliations
  • 1Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea. jspark65@ajou.ac.kr

Abstract

Febrile neutropenia (FN) is the major toxicity of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen in the treatment of diffuse large B-cell lymphoma (DLBCL). The prediction of neutropenia and FN is mandatory to continue the planned R-CHOP therapy resulting in successful anti-cancer treatment. The clinical features and patterns of neutropenia and FN from 181 DLBCL patients treated with R-CHOP were analyzed retrospectively. Sixty percent (60.2%) of patients experienced at least one episode of grade 4 neutropenia. Among them, 42.2% of episodes progressed to FN. Forty-eight percent (48.8%) of patients with FN was experienced their first FN during the first cycle of R-CHOP. All those patients never experienced FN again during the rest cycles of R-CHOP. Female, higher stage, international prognostic index (IPI), age > or =65 yr, comorbidities, bone marrow involvement, and baseline serum albumin < or =3.5 mg/dL were significant risk factors for FN by univariate analysis. Among these variables, comorbidities (P=0.009), bone marrow involvement (P=0.006), and female gender (P=0.024) were independent risk factors for FN based on multivariate analysis. On observing the patterns of neutropenia and FN, primary prophylaxis of granulocyte colony-stimulating factor (G-CSF) and antibiotics should be considered particularly in female patients, patients with comorbidities, or when there is bone marrow involvement of disease.

Keyword

Febrile Neutropenia; Lymphoma; Large B-Cell; Diffuse; R-CHOP Chemotherapy

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Antibodies, Monoclonal, Murine-Derived/adverse effects/*therapeutic use
Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use
Chemotherapy-Induced Febrile Neutropenia/*etiology
Cyclophosphamide/administration & dosage/adverse effects/therapeutic use
Demography
Doxorubicin/administration & dosage/adverse effects/therapeutic use
Female
Humans
Lymphoma, Large B-Cell, Diffuse/*drug therapy
Male
Middle Aged
Neoplasm Staging
Neutropenia/etiology/pathology
Prednisone/administration & dosage/adverse effects/therapeutic use
Retrospective Studies
Risk Factors
Sex Factors
Vincristine/administration & dosage/adverse effects/therapeutic use
Young Adult
Antibodies, Monoclonal, Murine-Derived
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

Figure

  • Fig. 1 Pattern of absolute neutrophil count (ANC) after each cycle of R-CHOP chemotherapy. ANC after the first cycle of R-CHOP was significantly lower than that of either baseline or after subsequent cycles of chemotherapy.


Cited by  1 articles

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
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
Cancer Res Treat. 2022;54(4):1268-1277.    doi: 10.4143/crt.2021.1168.


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