Abstract
Myelosuppression, particularly febrile neutropenia (FN), are serious dose-limiting toxicities that occur frequently during the first cycle of chemotherapy. Identifying patients most at risk of developing FN might help physicians to target prophylactic treatment with colony-stimulating factor (CSF), in order to decrease the incidence, or duration, of myelosuppression and facilitate delivery of chemotherapy as planned. We present a risk model for FN occurrence in the first cycle of chemotherapy, based on a subgroup of 240 patients with non-Hodgkin lymphoma (NHL) enroled in our European prospective observational study. Eligible patients had an International Prognostic Index of 0–3, and were scheduled to receive a new myelosuppressive chemotherapy regimen with at least four cycles. Clinically relevant factors significantly associated with cycle 1 FN were older age, increasing planned cyclophosphamide dose, a history of previous chemotherapy, a history of recent infection, and low baseline albumin (<35 g/l). Prophylactic CSF use and higher weight were associated with a significant protective effect. The model had high sensitivity (81%) and specificity (80%). Our model, together with treatment guidelines, may rationalise the clinical decision of whether to support patients with CSF primary prophylaxis based on their risk factor profile. Further validation is required.
Highlights
Data were obtained for 749 patients with histologically confirmed breast cancer, non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) who were enrolled in the in Chemotherapy – European Study Group (INC-EU) Prospective Observational European Neutropenia Study between January 2004 and May 2005
During cycle 1, febrile neutropenia (FN) occurred in 9% of patients and the incidence of FN across all cycles of chemotherapy was 22% (Fig 1)
Grade IV Chemotherapy-induced neutropenia (CIN) occurred in 35% of patients in cycle 1 and in 54% of patients across all cycles
Summary
Study design and patient selectionData were obtained for 749 patients with histologically confirmed breast cancer, NHL and Hodgkin lymphoma (HL) who were enrolled in the INC-EU Prospective Observational European Neutropenia Study between January 2004 and May 2005. Patients with NHL and an International Prognostic Index (IPI) of 0–3, and who were scheduled to receive a new myelosuppressive chemotherapy regimen with at least four cycles, were eligible for inclusion. General estimating equations (GEE)-based robust standard error (SE) estimates were used to allow for clustering by study centre. The impact of this choice was assessed by comparison with results based on conventional SE estimates. A model for the occurrence of FN in any cycle of chemotherapy was developed using similar techniques
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