title: 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.
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yong Won
authors.identifier: 0000-0002-3659-8126
authors.initials: YW
authors.lastname: Choi
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Seong Hyun
authors.identifier: 0000-0003-4098-1184
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Mi Sun
authors.identifier: 0000-0002-7081-9826
authors.initials: MS
authors.lastname: Ahn
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyun Woo
authors.identifier: 0000-0002-6879-9686
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Seok Yun
authors.identifier: 0000-0002-4995-9912
authors.initials: SY
authors.lastname: Kang
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jin-Hyuk
authors.identifier: 0000-0003-2387-204X
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: U Ram
authors.identifier: 0000-0001-8406-8886
authors.initials: UR
authors.lastname: Jin
authors.affiliation: Department of Oncology-Hematology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Joon Seong
authors.identifier: 0000-0001-7999-0577
authors.initials: JS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003710:Demography; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D012737:Sex Factors; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Diffuse; Febrile Neutropenia; Large B-Cell; Lymphoma; R-CHOP Chemotherapy