Department of Haematology, St George's University of London, UK.
Hematol Oncol. 2011 Dec;29(4):177-84. doi: 10.1002/hon.982. Epub 2011 Jan 18.
Severe neutropenia and febrile neutropenia (FN) are serious, dose-limiting side effects of chemotherapy for aggressive non-Hodgkin lymphoma (NHL). Observational data suggest that with current practice neutropenia management up to 23% of patients receiving CHOP-like regimens experience FN, and around half of patients do not receive the planned relative dose intensity (RDI). In this integrated analysis we assessed the efficacy of pegfilgrastim for preventing FN and related outcomes in patients with NHL. A literature search was used to identify chemotherapy regimens with an FN risk ≥15% that are used to treat lymphoma. Search results were then used to identify clinical trials in which these regimens were administered with pegfilgrastim primary prophylaxis. Individual patient data were available for three trials meeting the inclusion criteria, and these were combined in an integrated analysis. The primary outcome measure was the incidence of FN in any cycle. A total of 282 patients were included in the analysis [mean age 65 years (SD ± 12.5 years); 172 (61%) aged ≥ 65 years]. All patients had NHL and 244 (87%) received RCHOP-21. The incidence of FN in any cycle was 16% (95% CI 12-20%) (13% in patients aged <65 years; 18% in patients aged ≥65 years). Chemotherapy dose delays >3 days occurred in 26% (95% CI 20-31%) of patients, and was relatively consistent across age groups. Chemotherapy dose reductions ≥10% were seen in 43% (95% CI 37-49%) of patients and were more frequent in the elderly. Overall, 83% (95% CI 78-87%) of patients received ≥90% RDI (89% of patients aged <65 years; 78% of patients aged ≥65 years). In this integrated analysis of NHL patients at higher risk of FN receiving pegfilgrastim primary prophylaxis, the overall incidence of FN was 16% and a high proportion of both younger and elderly patients achieved RDI ≥90%.
中性粒细胞减少症和发热性中性粒细胞减少症（FN）是侵袭性非霍奇金淋巴瘤（NHL）化疗的严重剂量限制副作用。观察性数据表明，根据目前的实践，接受 CHOP 样方案治疗的患者中有 23%发生 FN，约一半的患者未接受计划的相对剂量强度（RDI）。在这项综合分析中，我们评估了培非格司亭预防 NHL 患者 FN 和相关结局的疗效。使用文献检索来确定 FN 风险≥15%的用于治疗淋巴瘤的化疗方案。然后使用检索结果来确定这些方案联合培非格司亭初级预防给药的临床试验。符合纳入标准的三项试验可获得个体患者数据，并对这些数据进行了综合分析。主要结局指标是任何周期 FN 的发生率。共有 282 例患者纳入分析[平均年龄 65 岁（标准差±12.5 岁）；172 例（61%）年龄≥65 岁]。所有患者均患有 NHL，244 例（87%）接受 RCHOP-21 治疗。任何周期 FN 的发生率为 16%（95%CI 12-20%）（年龄<65 岁的患者为 13%；年龄≥65 岁的患者为 18%）。化疗剂量延迟超过 3 天的患者占 26%（95%CI 20-31%），且在各年龄组中相对一致。化疗剂量减少≥10%的患者占 43%（95%CI 37-49%），且老年人更为常见。总体而言，83%（95%CI 78-87%）的患者接受了≥90%的 RDI（年龄<65 岁的患者为 89%；年龄≥65 岁的患者为 78%）。在这项接受培非格司亭初级预防的 FN 风险较高的 NHL 患者的综合分析中，FN 的总体发生率为 16%，且年轻和老年患者均有较高比例达到 RDI≥90%。
