Abstract
Background and Objective: Neutropenia that occurs after the first cycle of chemotherapy for non-Hodgkin’s Lymphoma (NHL) may predict its recurrence in the subsequent cycles. Moreover, it has also been reported to be a poor prognostic factor for the treatment outcome. Therefore, we aimed to observe the incidence of first cycle neutropenia and identify the potential risk factors for its occurrence among patients with NHL underwent chemotherapy. Methods: A retrospective cohort was conducted in Sardjito General Hospital, Yogyakarta, Indonesia to analyze 466 subjects during 2012-2018, confirmed NHL, age 17 or older, treatment-naïve, underwent first-line chemotherapy without any previous primary GCSF prophylaxis. Relevant clinical conditions, pre-treatment laboratory parameters and treatment factors were obtained from medical records. Univariate and multivariate analysis were done using logistic regression to determine the significant factors. Results: Among 466 NHL subjects, 241 (51.7%) received rituximab-containing regiment, with DLBCL as predominant subtype in 196 subjects (41.8%). Neutropenia occurred in 119 (25.5%; 95% CI 21.7-29.6%) of the cases, with 87 (73.2%) of them had moderate-severe neutropenia. Age older than 50 years old, use of rituximab-containing regiment, ANC ≤ 4.83×103 cells/mm3, and WBC ≤ 7.26×103 cells/mm3 were significant predisposing factors for first cycle neutropenia. A multivariate analysis showed two significant prognostic factors i.e., rituximab-containing regiment and ANC level ≤ 4.83×103 cells/mm3 with OR 2.18 (95% CI 1.38–3.43) and 2.30 (95%CI 1.49–3.57), respectively. Conclusion: The administration of rituximab-based regimen and pre-treatment ANC ≤ 4.83×103 cells/mm3 in NHL require more attention to anticipate the occurrence of neutropenia after the first chemotherapy cycle. Further investigation is required to validate risk model and identify subgroup who benefits from early use of growth factor.
Highlights
Combination chemotherapy is an essential treatment modality for non-Hodgkin lymphoma (NHL), mainly intermediate- to high-grade lymphoma [1]
CHOP regiment which consists of cyclophosphamide, doxorubicin, vincristine, and prednisone has been a standard of care for aggressive lymphoma for a long time, Diffuse Large B-Cell Lymphoma (DLBCL)
The regiment which was later known as rituximab with CHOP (R-CHOP) regiment has brought substantial improvement in terms of 10 years overall survival (OS) from 27.5% to 43.5% among older patients with DLBCL (60-80 years old) and 3 years OS from 84% to 93% in younger patient [2], [3]
Summary
Combination chemotherapy is an essential treatment modality for non-Hodgkin lymphoma (NHL), mainly intermediate- to high-grade lymphoma [1]. Despite achieved successful story of CHOP and later RCHOP regiment, myelotoxicity complication for this regiment in terms of neutropenia is still relatively high, with neutropenia incidence reported at minimum 20% for CHOP [4]. The incidence of severe neutropenia with RCHOP is reported to be higher than CHOP for more than 50%, with 40% of them later progressed into febrile neutropenia [5], [6]. Febrile neutropenia would predispose the patient to receive suboptimal relative dose intensity (RDI) and lead to unplanned hospitalization with longer length of stay [7]. Suboptimal chemotherapy later contributes to inferior survival in NHL and frequent hospitalization with longer stay means a high charge in economic cost [5], [7]. We aimed to observe the incidence of first cycle neutropenia and identify the potential risk factors for its occurrence among patients with NHL underwent chemotherapy
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