Risk factors for neutropenic fever in lymphoma patients receiving chemotherapy

Abstract

19616 Background: Neutropenic fever (NF) can be a serious complication of chemotherapy (CT) in lymphoma patients (pts), however the exact incidence with the current regimens and risk factors for NF are not well known. Methods: A retrospective cohort study was conducted to determine the incidence of NF, and logistic regression analysis were performed to identify the clinical and laboratory features correlated with NF in lymphoma. Medical records of all newly referred lymphoma pts (n=1046) in 2003 were reviewed. Results: 425 pts who received ≥ 1 cycle of treatment at MDACC were included in the analysis. Median age was 57 (range 17–87) with 262 (62%) newly diagnosed. Most common first regimens were (± rituxan) CHOP (29%), Hyper-CVAD ± Ara-c-MTX (23%), and ABVD (8%), with the total number of cycles were 1638 (median 3, range, 1–10). NF was observed in 23 % (97/425) of pts and 8 % (123/1638) of cycles, with the highest number in cycle 1 (49/123). The NF incidence among most common regimens were (± rituxan) Hyper-CVAD/ Ara-c/MTX 53% (31/58), Hyper-CVAD 24% (9/37), CHOP 22% (27/125), and ABVD 6% (2/34), and most common subtypes were MCL (33%), LCL (23%), HD (16%), and FL (13%). In the univariate regression analysis, CT, Hb, Ca, LDH, lymphocyte (ALC) and neutrophil (ANC) counts, were significantly associated with the NF. Using multivariate logistic regression, baseline ALC count (=1000 vs. >1000/μL: OR=2.251, 95% CI, 1.194 to 4.244, p=0.0121), Hb (<12 g/dL vs. ≥ 12g/dL: OR=2.117, 95% CI, 1.122 to 3.996, p=0.0207), age (>60 vs. ≤60: OR=2.035, 95% CI, 1.066 to 3.884, p=0.0312), CT (high vs. low risk: OR=2.913, 95% CI, 1.520 to 5.583, p=0.0013) were the most important baseline risk factors for NF in cycle-1. Conclusions: The incidence of NF in this population is high in cycle 1. Baseline pt characteristics including old age, high risk CT, low ALC and Hb were found to be significant risk factors predictive for NF in cycle-1. These findings could be useful to identify high risk pts for consideration of treatment approaches for prevention of NF. No significant financial relationships to disclose.