title: Severe neutropenia and relative dose intensity among patients<65 and ≥65 years with non-Hodgkin's lymphoma receiving CHOP-based chemotherapy.
abstract: OBJECTIVE
  The objective of this study was to describe the incidence of grade 3/4 neutropenia, patterns of chemotherapy treatment, and granulocyte colony-stimulating factor (G-CSF) use patterns among patients with non-Hodgkin's lymphoma (NHL)<65 and ≥65 years.
  
  
  METHODS
  This retrospective, observational study included adult patients with NHL who received cyclophosphamide, doxorubicin, vincristine, and prednisone±rituximab (CHOP±R) from January 2006 to June 2010.
  
  
  RESULTS
  A total of 1,579 patients were included, with 54.1%<65 years and 45.9%≥65 years. Most received CHOP-R on a Q3W schedule. Among patients<65 years, the incidence of grade 3/4 neutropenia was 52.3%, the mean relative dose intensity (RDI) was 80.4%, and the incidences of dose delays and reductions were 26.5 and 9.6%, respectively. Among patients≥65 years, the incidence of grade 3/4 neutropenia was 63.2%, the mean RDI was 73.9%, and the incidences of dose delays and reductions were 24.6 and 24.9%, respectively. Most patients (86.9%) received G-CSF. Among patients<65 years, 71.9, 17.4, and 10.7% first received G-CSF as primary prophylaxis, secondary prophylaxis, or treatment, respectively. Among patients≥65 years, 80.1, 11.6, and 8.3% first received G-CSF as primary prophylaxis, secondary prophylaxis, or treatment, respectively.
  
  
  CONCLUSIONS
  Chemotherapy regimens and schedules were similar among age groups. Grade 3/4 neutropenia, reduced RDI, and dose delays were common in both age groups, though patients≥65 years had a higher incidence of dose reductions. In spite of these similarities, patients<65 years were less likely to receive primary prophylactic G-CSF. Thus, careful assessment of neutropenia risk factors is needed across age groups to determine appropriate G-CSF use and support planned chemotherapy.
authors.affiliation: The West Clinic, 100 N Humphreys Blvd, Memphis, TN, 38120, USA, lschwartzberg@westclinic.com.
authors.forename: Lee S
authors.initials: LS
authors.lastname: Schwartzberg
authors.forename: Mansoor
authors.initials: M
authors.lastname: Saleh
authors.forename: Sadie
authors.initials: S
authors.lastname: Whittaker
authors.forename: Esteban
authors.initials: E
authors.lastname: Abella
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone