Study confirms impact of febrile neutropenia on chemotherapy delivery in NHL

Data presented at the 15th European Hematology Association (EHA) congress in Barcelona, highlights the impact of febrile neutropenia (FN) on chemotherapy delivery in non-Hodgkin lymphoma (NHL) patients. The IMPACT NHL study showed that unplanned hospitalisations, delays in chemotherapy and reductions of chemotherapy dose leading to suboptimal relative dose intensity (RDI) of chemotherapy were more frequent in patients who experienced FN than those who did not.

In the study, patients (> 18 years) with NHL were administered Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone (CHOP) chemotherapy either every two weeks (CHOP-14) or every three weeks (CHOP-21) in combination with the monoclonal antibody rituximab (R). Neutropenia management and granulocyte-colony stimulating factor (G-CSF) use were entirely at the discretion of the treating physician, in order to prevent FN. A total of 1,111 patients with diffuse large B cell lymphoma were included in the current study analysis and 214 patients experienced FN.

In the R-CHOP-21 group, optimal chemotherapy dose intensity of 90% or more was maintained by three quarters (76%) of patients who did not experience FN, but only 62% of those who did experience FN, achieved this target. For the R-CHOP-14 group this was 71% and 37%, respectively. Patients were less likely to reach or maintain optimal chemotherapy dose intensity if they experienced FN. Previous data shows that a reduction in CHOP chemotherapy dose intensity below 90% may decrease survival in patients with aggressive NHL.

"These data confirm the significant impact febrile neutropenia can have on chemotherapy delivery in NHL, possibly reducing the favourable outcome of the treatment. There is a need for early prophylaxis with G-CSFs in those patients at risk," said Dr Ruth Pettengell, presenting author of the study and Senior Lecturer in Haematology and Honorary Consultant in Oncology at St George's Hospital Medical School, University of London.

Unplanned hospitalisations were also greater in patients who experienced FN (79% versus 18% in R-CHOP-21; 78% versus 21% in R-CHOP-14).

Based on these data from everyday clinical practice, the authors conclude physicians should implement guidelines on G-CSF use and G-CSF primary prophylaxis should be considered for NHL patients receiving R-CHOP-21 chemotherapy, who are assessed as having an overall FN risk of 20% or higher, and for all patients receiving R-CHOP-14.

Use of G-CSF primary phrophylaxis to prevent FN differed between the two groups; less than half of R-CHOP-21 patients (36%) were given G-CSF primary prophylaxis, compared to 84% of the R-CHOP-14 group and incidence of FN was 19% and 20% respectively.

SOURCE Amgen