title: Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP-R, or CNOP chemotherapy for intermediate-grade non-Hodgkin lymphoma.
abstract: BACKGROUND
  Hospitalization for chemotherapy-induced febrile neutropenia is associated with substantial cost and may negatively impact clinical outcome due to associated dose attenuation.
  
  
  METHODS
  Medical records of 1355 patients with intermediate-grade non-Hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or similar chemotherapy were reviewed. The potential risk factors associated with first hospitalization for febrile neutropenia were evaluated.
  
  
  RESULTS
  In the current study, 230 patients (17%) experienced 1 or more hospitalizations for febrile neutropenia and greater than one-half of all initial hospitalizations for febrile neutropenia occurred in Cycles 1 or 2. Increased risk of hospitalization for febrile neutropenia, based on Cox proportional hazards models, was significantly associated with the following characteristics: age 65 years or older (hazard ratio [HR] = 1.79; 95% confidence interval [95% CI], 1.35-2.37), serum albumin level at presentation less than or equal to 3.5 g/dL (HR = 1.34; 95% CI, 1.01-1.78), planned average relative dose intensity greater than or equal to 80% (HR = 2.70; 95% CI, 1.47-4.98), baseline absolute neutrophil count less than 1500/mm3 (HR = 1.98; 95% CI, 1.28-3.06), and the presence of hepatic disease (HR = 2.18; 95% CI, 1.11-4.28). Lack of early granulocyte colony-stimulating factor in Cycles 1 and 2 was also associated with increased risk of hospitalization for febrile neutropenia, but this did not reach statistical significance. A composite risk score based on these potential risk factors effectively distinguished patients at greater risk of hospitalization for febrile neutropenia (P < 0.001), the majority of which were observed during the first cycle of chemotherapy.
  
  
  CONCLUSIONS
  The data from the current study demonstrated that the risk of initial hospitalization for febrile neutropenia occured early in the course of CHOP-like chemotherapy. Identified risk factors for febrile neutropenia hospitalization may facilitate the use of targeted supportive care.
authors.affiliation: Department of Medicine, University of Rochester School of Medicine and Dentistry and the James P Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York 14642, USA. Gary_Lyman@urmc.rochester.edu
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: David J
authors.initials: DJ
authors.lastname: Delgado
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D009503:Neutropenia / Q000139:chemically induced* / Q000628:therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone; D011241:Prednisone