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Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients

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Abstract

The long-term effects of pegfilgrastim administered in the first cycle of chemotherapy in day-to-day practice remain unclear. We retrospectively identified 114 patients aged ≥ 70 years with diffuse large B-cell lymphoma who received a rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone (R-CHOP) regimen in our institution. Twenty-six patients received pegfilgrastim (pegfilgrastim group); of the 88 patients scheduled to receive conventional granulocyte-colony stimulating factor (G-CSF) when their neutrophil count decreased (neut-adjusted-G group), conventional G-CSF was ultimately administered to 57. During the first cycle of R-CHOP, the incidence of febrile neutropenia was lower in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 18%, p = 0.020). Throughout all cycles, a higher proportion of patients exhibited sustained relative dose intensity (≥ 80%) in the pegfilgrastim group than in the neut-adjusted-G group (25% vs. 4.0%, p = 0.008). A lower proportion of patients received a reduced dose in the second cycle in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 10%, p = 0.116). Although the differences were not significant, the pegfilgrastim group showed higher progression-free survival and overall survival than the neut-adjusted-G group. Adequate prevention of febrile neutropenia using pegfilgrastim during the first cycle of R-CHOP may contribute to avoidance of dose intensity reduction in all cycles.

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Acknowledgments

The authors would like to thank medical affairs division of the University of Tokyo hospital for calculating medical costs, Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Masataka Ise, Kensuke Matsuda, Arika Shimura, Yosuke Masamoto & Mineo Kurokawa

  2. Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan

    Mineo Kurokawa

Authors
  1. Masataka Ise
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  2. Kensuke Matsuda
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  3. Arika Shimura
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  4. Yosuke Masamoto
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  5. Mineo Kurokawa
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Contributions

MI and KM designed the research. KM, AS, YM and MK advised the research design and analyses. MI collected the patient’s data and analyzed the data. MI and KM wrote the paper. All authors revised the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Mineo Kurokawa.

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Conflict of interest

Kensuke Matsuda received the lecture fee from Kyowa Kirin. Arika Shimura received the lecture fee from Eisai. Yosuke Masamoto received the lecture fee from Janssen Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Nippon Shinyaku, Eisai, Bristol-Myers Squibb, Ono Pharmaceutical, Celgene, and Kyowa Kirin. Mineo Kurokawa received the lecture fee from MSD, Astellas, AbbVie, Amgen, Sanwa Chemistry, Shire Japan, Daiichi Sankyo, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Chugai Pharmaceutical, Boehringer Ingelheim, Janssen Pharmaceutical, Otsuka Pharmaceutical, Nippon Shinyaku, Eisai, Bioverativ Japan, Ono Pharmaceutical, Celgene, and Kyowa Kirin. Mineo Kurokawa received the research funding from Pfizer, Otsuka Pharmaceutical, Chugai Pharmaceutical, Astellas, Kyowa Kirin, Takeda Pharmaceutical, MSD, Teijin, Eisai, Sumitomo Dainippon Pharma, Nippon Shinyaku, Daiichi Sankyo, Ono Pharmaceutical, and AbbVie. None of these is related to the current study.

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Ise, M., Matsuda, K., Shimura, A. et al. Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients. Int J Hematol 113, 823–831 (2021). https://doi.org/10.1007/s12185-021-03118-6

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  • DOI: https://doi.org/10.1007/s12185-021-03118-6

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