Patterns of neutropenia and risk factors for febrile neutropenia of diffuse large B-cell lymphoma patients treated with rituximab-CHOP.

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 >/=65 yr, comorbidities, bone marrow involvement, and baseline

serum albumin </=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.