Pegfilgrastim Prophylaxis Is Effective in the Prevention of Febrile Neutropenia and Reduces Mortality in Patients Aged ≥ 75 Years with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Cohort Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion: Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.
Abstract
Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion: Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.
참고문헌 (30)
- Coiffier B, "CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma", N Engl J Med, 346, pp.235~242 (2002)
- Pfreundschuh M, "CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma : 6-year results of an open-label randomised study of the MabThera International Trial(MInT)Group", Lancet Oncol, 12, pp.1013~1022 (2011)
- Pettengell R, "Impact of febrile neutropenia on R-CHOP chemotherapy delivery and hospitalizations among patients with diffuse large B-cell lymphoma", Support Care Cancer, 20, pp.647~652 (2012)
- Fust K, "Cost-effectiveness analysis of prophylaxis treatment strategies to reduce the incidence of febrile neutropenia in patients with early-stage breast cancer or non-Hodgkin lymphoma", Pharmacoeconomics, 35, pp.425~438 (2017)
- Fust K, "Granulocyte colony-stimulating factors in the prevention of febrile neutropenia : review of cost-effectiveness models", Expert Rev Pharmacoecon Outcomes Res, 17, pp.39~52 (2017)
- Aapro MS, "2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours", Eur J Cancer, 47, pp.8~32 (2011)
- 최용원, "Patterns of Neutropenia and Risk Factors for Febrile Neutropenia of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP", Journal of Korean Medical Science, 29(11), pp.1493~1500 (2014), 대한의학회
- Lyman GH, "Risk factors for febrile neutropenia among patients with cancer receiving chemotherapy : a systematic review", Crit Rev Oncol Hematol, 90, pp.190~199 (2014)
- Lyman GH, "Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin’s lymphoma receiving CHOP chemotherapy", Leuk Lymphoma, 44, pp.2069~2076 (2003)
- Salar A, "The need for improved neutropenia risk assessment in DLBCL patients receiving R-CHOP-21 : findings from clinical practice", Leuk Res, 36, pp.548~553 (2012)
- Yokoyama M, "Incidence and risk factors for febrile neutropenia in Japanese patients with non-Hodgkin B cell lymphoma receiving R-CHOP : 2-year experience in a single center(STOP FN in NHL 2)", Support Care Cancer, 28, pp.571~579 (2020)
- Crawford J, "Myeloid growth factors, version 2.2017, NCCN clinical practice guidelines in oncology", J Natl Compr Canc Netw, 15, pp.1520~1541 (2017)
- Weycker D, "Use and effectiveness of pegfilgrastim prophylaxis in US clinical practice : a retrospective observational study", BMC Cancer, 19, pp.792~ (2019)
- Holmes FA, "Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia : a multicenter dose-finding study in women with breast cancer", Ann Oncol, 13, pp.903~909 (2002)
- Holmes FA, "Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in pati-ents with high-risk stage II or stage III", IV breast cancer, 2002, pp.20, 727~731
- Naeim A, "Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis : a retrospective United States claims analysis of granulocyte colony-stimulating factors(G-CSF)", BMC Cancer, 13, pp.11~ (2013)
- Henk HJ, "Comparative effectiveness of pegfilgrastim, filgrastim, and sargramostim prophylaxis for neutropenia-related hospitalization : two US retrospective claims analyses", J Med Econ, 16, pp.160~168 (2013)
- Kim SJ, "Highly elevated serum lactate dehydrogenase is associated with central nervous system relapse in patients with diffuse large B-cell lymphoma : results of a multicenter prospective cohort study", Oncotarget, 7, pp.72033~72043 (2016)
- Hong J, "Improved prognostic stratification using NCCN-and GELTAMO-international prognostic index in patients with diffuse large B-cell lymphoma", Oncotarget, 8, pp.92171~92182 (2017)
- Cheson BD, "Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma : the Lugano classification", J Clin Oncol, 32, pp.3059~3068 (2014)
- Peyrade F, "Attenuated immunochemotherapy regimen(R-miniCHOP)in elderly patients older than 80 years with diffuse large B-cell lymphoma : a multicentre, single-arm, phase 2 trial", Lancet Oncol, 12, pp.460~468 (2011)
- Intragumtornchai T, "A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin’s lymphoma", Leuk Lymphoma, 37, pp.351~360 (2000)
- Matsuda K, "Primary prophylaxis with pegfilgrastim in patients with newly-diagnosed diffuse large B-cell lymphoma : propensity score and instrumental variable analyses", Leuk Lymphoma, 61, pp.2435~2441 (2020)
- Ise M, "Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients", Int J Hematol, 113, pp.823~831 (2021)
- Pettengell R, "Pegfilgrastim primary prophylaxis in patients with non-Hodgkin lymphoma : results from an integrated analysis", Hematol Oncol, 29, pp.177~184 (2011)
- Crawford J, "Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy : the results of a prospective nationwide study of oncology practice", J Natl Compr Canc Netw, 6, pp.109~118 (2008)
- Bataillard EJ, "Impact of R-CHOP dose intensity on survival outcomes in diffuse large B-cell lymphoma : a systematic review", Blood Adv, 5, pp.2426~2437 (2021)
- Dlugosz-Danecka M, "The average relative dose intensity of R-CHOP is an independent factor determining favorable overall survival in diffuse large B-cell lymphoma patients", Cancer Med, 8, pp.1103~1109 (2019)
- Yoo KH, "Lymphoma epidemiology in Korea and the real clinical field including the Consortium for Improving Survival of Lymphoma(CISL)trial", Int J Hematol, 107, pp.395~404 (2018)
- Hill G, "Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin’s lymphoma : cost-effectiveness analyses", J Med Econ, 17, pp.32~42 (2014)