Abstract
BackgroundA classification tree was used to analyze background factors for granulocyte colony-stimulating factor (G-CSF) preparation selection for febrile neutropenia (FN) prophylaxis in Japanese patients with non-Hodgkin B-cell lymphoma receiving the first R-CHOP cycle.MethodsThis was a subanalysis of the retrospective observational study STOP FN in NHL 2 (UMIN000029534). Patient characteristics, changes in neutrophil count, incidence and severity of neutropenia, and risk factors for dose reduction/delay of R-CHOP were assessed by G-CSF formulation.ResultsAmong 234 patients in cycle 1, 25.6% received no G-CSF preparation, 52.1% received daily G-CSF, and 22.2% received pegfilgrastim. Pegfilgrastim use was most frequent among patients aged ≥ 80 years, while that of daily G-CSF was most frequent in patients with lymphocyte count (LC) < 1000 cells/μL. Changes in neutrophil count were more marked with pegfilgrastim compared with daily G-CSF and no G-CSF. Relevant factors for G-CSF preparation selection in the first R-CHOP cycle were age ≥ 80 years and LC < 1000 cells/μL; for chemotherapy dose reduction were FN onset in cycle 1 and female sex; and for dose delay was hemoglobin (< 12 g/dL). After cycle 2 and onward, pegfilgrastim use increased markedly (72.6%) compared with cycle 1 (22.2%), with significantly greater proportions continuing pegfilgrastim use and switching from daily G-CSF.ConclusionRelevant factors for G-CSF preparation selection were age ≥ 80 years and LC < 1000 cells/μL. The use of pegfilgrastim increased markedly after cycle 2. These results may be useful for selecting appropriate G-CSF preparations in the first R-CHOP cycle.Trial registrationUMIN000029534; registered on 13 October 2017, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033733.
Highlights
A classification tree was used to analyze background factors for granulocyte colony-stimulating factor (G-CSF) preparation selection for febrile neutropenia (FN) prophylaxis in Japanese patients with non-Hodgkin B-cell lymphoma receiving the first R-CHOP cycle
We reported that Japanese patients treated with two types of G-CSF preparations, daily G-CSF and pegfilgrastim, had incidences of FN of 7.3 and 3.7%, respectively, while patients who did not receive any G-CSF preparation had an incidence of FN of 23.0% [10]
G-CSF selection and outcomes in cycle 1 As one of the specific objectives of this subanalysis was to identify the patient background factors that may aid in the selection of G-CSF preparations, we developed a classification tree using the background factors of patients undergoing the first R-CHOP cycle as explanatory variables to predict the FN incidence rates at that time (Fig. 1)
Summary
A classification tree was used to analyze background factors for granulocyte colony-stimulating factor (G-CSF) preparation selection for febrile neutropenia (FN) prophylaxis in Japanese patients with non-Hodgkin B-cell lymphoma receiving the first R-CHOP cycle. Febrile neutropenia (FN) is the most common and severe complication of patients receiving chemotherapy for cancer [1]. A study of 2692 patients undergoing chemotherapy in a community oncology setting in the US reported that first-cycle dose reductions, in response to both the perceived risk of FN and the actual occurrence of FN, were common (23.6%). Several risk factors for the development of FN have been recently identified among patients with non-Hodgkin Bcell lymphoma (B-NHL) receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (RCHOP) chemotherapy [7]. The main risk factors are albumin < 35 g/L or RDI < 85%, and lack of prophylaxis against FN
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