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Severe neutropenia and relative dose intensity among patients <65 and ≥65 years with non-Hodgkin’s lymphoma receiving CHOP-based chemotherapy

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Abstract

Purpose

The objective of this study was to describe the incidence of grade 3/4 neutropenia, patterns of chemotherapy treatment, and granulocyte colony-stimulating factor (G-CSF) use patterns among patients with non-Hodgkin’s lymphoma (NHL) <65 and ≥65 years.

Methods

This retrospective, observational study included adult patients with NHL who received cyclophosphamide, doxorubicin, vincristine, and prednisone ± rituximab (CHOP ± R) from January 2006 to June 2010.

Results

A total of 1,579 patients were included, with 54.1 % <65 years and 45.9 % ≥65 years. Most received CHOP-R on a Q3W schedule. Among patients <65 years, the incidence of grade 3/4 neutropenia was 52.3 %, the mean relative dose intensity (RDI) was 80.4 %, and the incidences of dose delays and reductions were 26.5 and 9.6 %, respectively. Among patients ≥65 years, the incidence of grade 3/4 neutropenia was 63.2 %, the mean RDI was 73.9 %, and the incidences of dose delays and reductions were 24.6 and 24.9 %, respectively. Most patients (86.9 %) received G-CSF. Among patients <65 years, 71.9, 17.4, and 10.7 % first received G-CSF as primary prophylaxis, secondary prophylaxis, or treatment, respectively. Among patients ≥65 years, 80.1, 11.6, and 8.3 % first received G-CSF as primary prophylaxis, secondary prophylaxis, or treatment, respectively.

Conclusions

Chemotherapy regimens and schedules were similar among age groups. Grade 3/4 neutropenia, reduced RDI, and dose delays were common in both age groups, though patients ≥65 years had a higher incidence of dose reductions. In spite of these similarities, patients <65 years were less likely to receive primary prophylactic G-CSF. Thus, careful assessment of neutropenia risk factors is needed across age groups to determine appropriate G-CSF use and support planned chemotherapy.

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Acknowledgments

The authors thank Sharon Hunter, Sejal Badre, and Wayne Sheldon for the biostatistical support. Kerri Hebard-Massey (Amgen Inc.) provided medical writing support.

Conflict of interest

This study was sponsored by Amgen Inc. SW is an employee of and stockholder in Amgen Inc. EA was an employee of Amgen Inc. at the time the study was performed. LS has a consultancy or advisory role with Amgen Inc. MS has no conflicts to declare. Authors had full control of the primary data and agree to allow the journal to review the data if requested.

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Authors and Affiliations

  1. The West Clinic, 100 N Humphreys Blvd, Memphis, TN, 38120, USA

    Lee S. Schwartzberg

  2. Georgia Cancer Specialists, Duluth, GA, USA

    Mansoor Saleh

  3. Amgen Inc., Thousand Oaks, CA, USA

    Sadie Whittaker & Esteban Abella

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  1. Lee S. Schwartzberg
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  2. Mansoor Saleh
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Correspondence to Lee S. Schwartzberg.

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Schwartzberg, L.S., Saleh, M., Whittaker, S. et al. Severe neutropenia and relative dose intensity among patients <65 and ≥65 years with non-Hodgkin’s lymphoma receiving CHOP-based chemotherapy. Support Care Cancer 22, 1833–1841 (2014). https://doi.org/10.1007/s00520-014-2157-8

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  • DOI: https://doi.org/10.1007/s00520-014-2157-8

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