Impact of febrile neutropenia on R-CHOP chemotherapy delivery and hospitalizations among patients with diffuse large B-cell lymphoma

Ruth Pettengell, Hans E Johnsen, Pieternella J Lugtenburg, Antonio Salar Silvestre, Ulrich Dührsen, Francesca G Rossi, Matthias Schwenkglenks, Kate Bendall, Zsolt Szabo, Ulrich Jaeger, Ruth Pettengell, Hans E Johnsen, Pieternella J Lugtenburg, Antonio Salar Silvestre, Ulrich Dührsen, Francesca G Rossi, Matthias Schwenkglenks, Kate Bendall, Zsolt Szabo, Ulrich Jaeger

Abstract

Purpose: This analysis from an observational study of clinical practice describes the impact of febrile neutropenia (FN) on chemotherapy delivery and hospitalizations.

Methods: Adults with diffuse large B-cell lymphoma (DLBCL) scheduled to receive ≥ 3 cycles of 2- or 3-weekly CHOP with rituximab (R-CHOP-14/21) were eligible. Primary outcome was incidence of FN.

Results: FN data were available for 409 patients receiving R-CHOP-14 and 702 patients receiving R-CHOP-21. FN incidence was R-CHOP-14, 20% (81/409) and R-CHOP-21, 19% (133/702). Rates of primary prophylaxis with granulocyte-colony stimulating factor were R-CHOP-14, 84% (345/409) and R-CHOP-21, 36% (252/702). A large number of patients experienced their first FN episode in cycle 1 (R-CHOP-14, 24/81 [30%]; R-CHOP-21, 63/133 [47%]). Multiple risk factors (≥ 2) for FN were more frequent in patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 60/81 [74%] versus 179/328 [55%]; R-CHOP-21, 98/133 [74%] versus 339/569 [60%]). A similar trend was observed for unplanned hospitalizations (R-CHOP-14, 63/81 [78%] versus 68/328 [21%]; R-CHOP-21, 105/133 [79%] versus 100/569 [18%]). Achievement of chemotherapy relative dose intensity ≥ 90% was lower among patients experiencing FN than in patients not experiencing FN (R-CHOP-14, 30/81 [37%] versus 234/328 [71%]; R-CHOP-21, 83/133 [62%] versus 434/569 [76%]).

Conclusions: In patients with DLBCL treated with R-CHOP-14 or R-CHOP-21, patients with an event of FN were more likely to experience suboptimal chemotherapy delivery and increased incidence of unplanned hospitalizations than those without FN. FN-related hospitalizations are likely to impact chemotherapy delivery and to incur substantial costs.

Figures

Fig. 1
Fig. 1
Dose delays of >3 days in patients who received at least two chemotherapy cycles, dose reductions of ≥10% in cyclophosphamide or doxorubicin in any cycle, and patients achieving RDI ≥90%. For dose delays, superscript a, N = 80; superscript b, N = 325; superscript c, N = 128; superscript d, N = 563

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