Multivariate analysis of febrile neutropenia occurrence in patients with non-Hodgkin lymphoma: data from the INC-EU Prospective Observational European Neutropenia Study |
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Authors: | Ruth Pettengell,ré Bosly,Thomas D. Szucs,Christian Jackisch,Robert Leonard,Robert Paridaens,Manuel Constenla, Matthias Schwenkglenks,for the Impact of Neutropenia in Chemotherapy - European Study Group |
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Affiliation: | Cellular and Molecular Medicine, St George's University of London, Cranmer Terrace, London, UK;, Service d'Hématologie, Cliniques Universitaires UCL, Godinne, Belgium;, European Centre of Pharmaceutical Medicine, University of Basel, c/o ECPM Executive Office, University Hospital, Basel, Switzerland;, Department of Gynaecology and Obstetrics, Klinikum Offenbach, Offenbach, Germany;, Cancer Services &Clinical Haematology, Charing Cross Hospital, London, UK;, Department of Medical Oncology, University Hospital Gasthuisberg, Leuven, Belgium;, and Servicio de Oncologia, Complexo Hospitalario de Pontevedra, Pontevedra, Spain |
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Abstract: | Myelosuppression, particularly febrile neutropenia (FN), are serious dose-limiting toxicities that occur frequently during the first cycle of chemotherapy. Identifying patients most at risk of developing FN might help physicians to target prophylactic treatment with colony-stimulating factor (CSF), in order to decrease the incidence, or duration, of myelosuppression and facilitate delivery of chemotherapy as planned. We present a risk model for FN occurrence in the first cycle of chemotherapy, based on a subgroup of 240 patients with non-Hodgkin lymphoma (NHL) enroled in our European prospective observational study. Eligible patients had an International Prognostic Index of 0–3, and were scheduled to receive a new myelosuppressive chemotherapy regimen with at least four cycles. Clinically relevant factors significantly associated with cycle 1 FN were older age, increasing planned cyclophosphamide dose, a history of previous chemotherapy, a history of recent infection, and low baseline albumin (<35 g/l). Prophylactic CSF use and higher weight were associated with a significant protective effect. The model had high sensitivity (81%) and specificity (80%). Our model, together with treatment guidelines, may rationalise the clinical decision of whether to support patients with CSF primary prophylaxis based on their risk factor profile. Further validation is required. |
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Keywords: | Non-Hodgkin lymphoma neutropenia chemotherapy risk factors |
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