title: Patterns of growth factor usage and febrile neutropenia among older patients with diffuse large B-cell non-Hodgkin lymphoma treated with CHOP or R-CHOP: the Intergroup experience (CALGB 9793; ECOG-SWOG 4494).
abstract: Patterns of myeloid growth factor (GF) usage and febrile neutropenia (FN) were examined in patients >60 years of age with diffuse large B-cell non-Hodgkin lymphoma (DLBCL) enrolled on CALGB 9793/ECOG-SWOG 4494, receiving initial therapy with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or rituximab + CHOP (R-CHOP). Myeloid GFs were administered to 256/520 (49%) patients. Indications for use were: prevent dose reduction/dose delay (81%, 207/256); treat FN or non-febrile neutropenia (NFN) (19%, 48/256). One or more FN episodes occurred in 41% (212/520) of patients, with FN most often in cycle 1 (38% of episodes). In multivariate analysis, risk factors for FN included age >65 years (odds ratio (OR) = 2.6, 95% CI: [1.4, 4.9]) and anemia (hemoglobin <12 g/dl) (OR =2.2, 95% confidence intervals (CI): [1.4, 3.5]. Myeloid GF use was common in this older DLBCL population receiving CHOP-based therapy, as was FN, especially during cycle one. Risk factors predictive for FN should be used prospectively to identify patients for whom myeloid GFs are best utilized.
authors.affiliation: a Division of Hematology, Oncology, and Transplantation , University of Minnesota and Hennepin County Medical Center , Minneapolis , MN , USA.|b Division of Infectious Disease , University of Minnesota , Minneapolis , MN , USA.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Morrison
authors.affiliation: c Eastern Cooperative Oncology Group , Statistical Center , Boston , MA , USA.
authors.forename: Edie A
authors.initials: EA
authors.lastname: Weller
authors.affiliation: d Department of Medicine, Division of Hematology , Mayo Clinic , Rochester , MN , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.affiliation: c Eastern Cooperative Oncology Group , Statistical Center , Boston , MA , USA.
authors.forename: Shuli
authors.initials: S
authors.lastname: Li
authors.affiliation: e Wilmot Cancer Center , University of Rochester Medical Center , Rochester , NY , USA.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Fisher
authors.affiliation: f Division of Hematology , Lombardi Cancer Center, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Cheson
authors.affiliation: g Division of Hematology, Oncology, and Transplantation , University of Minnesota , Minneapolis , MN , USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Peterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003115:Colony-Stimulating Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D064147:Febrile Neutropenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003115:Colony-Stimulating Factors; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Lymphoma; diffuse large B-cell lymphoma; elderly; myeloid growth factor; neutropenia