Korean J Intern Med.  2021 Sep;36(5):1181-1189. 10.3904/kjim.2020.206.

Risk factors for neutropenic fever in non-Hodgkin’s lymphoma patients with primary granulocyte colony-stimulating factor prophylaxis

Affiliations
  • 1Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
  • 3Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
  • 4Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
  • 5Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

Abstract

Background/Aims
Febrile neutropenia (FN) interferes with the proper chemotherapy dose density or intensity in non-Hodgkin’s lymphoma (NHL) patients. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab has an intermediate FN risk. Prophylactic granulocyte colony-stimulating factor (G-CSF) support is recommended for patients with other host-related risk factors.
Methods
We evaluated the risk factors for FN-related admission in NHL patients who have received primary G-CSF (lenograstim) prophylaxis.
Results
Data from 148 patients were analyzed. The incidence of neutropenic fever was 96 events (12.2%), and the median period was 3.85 days (range, 0 to 5.9); the median duration of neutropenia was 4.21 days (range, 3.3 to 5.07). Eighty-three FN-related admissions were reported. Advanced age (> 60 years), female sex, a low albumin level, and prednisone use were associated with FN-related admission in multivariable analysis (p = 0.010, p < 0.001, and p = 0.010, respectively). A comparison between diffuse large B-cell lymphoma patients treated with R-CHOP and pegylated G-CSF and those treated with R-CHOP and lenograstim did not reveal significant differences in the FN-related admission rate between the two groups, although the lenograstim-treated group had a higher incidence of severe neutropenia.
Conclusions
Elderly patients, female patients, and patients with low albumin levels need to be actively followed-up for FN even when primary prophylaxis with G-CSF has been used.

Keyword

Febrile neutropenia; Lymphoma; non-Hodgkin; Elderly; Female; Albumin
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