title: Comparative effectiveness of white blood cell growth factors on neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma treated with chemotherapy.
abstract: OBJECTIVE
  To determine the effect of colony-stimulating factor (CSF) on incidence of febrile neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma (NHL) treated with chemotherapy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results-Medicare database.
  
  
  METHODS
  Thirteen thousand two hundred twenty-three people diagnosed with NHL at age 65 and older (mean age 74.9, range 65-102) in 1992 to 2002 who received chemotherapy within 12 months of diagnosis.
  
  
  METHODS
  Primary prophylaxis was defined as CSF administered at the start of chemotherapy before febrile neutropenia or infection; secondary prophylaxis was defined as CSF use after febrile neutropenia or infection.
  
  
  RESULTS
  Participants with five to nine administrations of primary prophylactic CSF had a 42% lower risk of febrile neutropenia (odds ratio (OR)=0.58, 95% confidence interval (CI)=0.41-0.83), and participants with 10 or more administrations had a 48% lower risk (OR=0.52, 95% CI=0.36-0.76) after adjusting for age, stage, histology, and comorbidity. Results did not differ significantly after adjusting for propensity score of receiving CSF. There was no significant association between primary prophylactic CSF and overall survival, but secondary prophylactic CSF was significantly associated with better survival. Four to 10 administrations of secondary prophylactic CSF was associated with 9% lower mortality risk (hazard ratio (HR)=0.91, 95% CI=0.84-0.99), 11 to 23 administrations was associated with 23% lower mortality risk (HR=0.77, 95% CI=0.71-0.84) and 24 or more administrations was associated with 13% lower mortality risk (HR=0.87, 95% CI+0.79-0.95) than in participants not receiving CSF after neutropenia or infection.
  
  
  CONCLUSIONS
  Primary prophylactic CSF was observed to be effective in reducing the incidence of neutropenia and infection. These findings substantiate the clinical guidelines for recommending prophylactic CSF in older people with NHL receiving chemotherapy.
authors.affiliation: Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, Texas, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Gruschkus
authors.forename: David
authors.initials: D
authors.lastname: Lairson
authors.forename: J Kay
authors.initials: JK
authors.lastname: Dunn
authors.forename: Jan
authors.initials: J
authors.lastname: Risser
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009503:Neutropenia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors