Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP-R, or CNOP chemotherapy for intermediate-grade non-Hodgkin lymphoma
✍ Scribed by Gary H. Lyman; David J. Delgado
- Publisher
- John Wiley and Sons
- Year
- 2003
- Tongue
- English
- Weight
- 389 KB
- Volume
- 98
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
Background:
Hospitalization for chemotherapy-induced febrile neutropenia is associated with substantial cost and may negatively impact clinical outcome due to associated dose attenuation.
Methods:
Medical records of 1355 patients with intermediate-grade non-hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (chop) or similar chemotherapy were reviewed. the potential risk factors associated with first hospitalization for febrile neutropenia were evaluated.
Results:
In the current study, 230 patients (17%) experienced 1 or more hospitalizations for febrile neutropenia and greater than one-half of all initial hospitalizations for febrile neutropenia occurred in cycles 1 or 2. increased risk of hospitalization for febrile neutropenia, based on cox proportional hazards models, was significantly associated with the following characteristics: age 65 years or older (hazard ratio [hr] = 1.79; 95% confidence interval [95% ci], 1.35-2.37), serum albumin level at presentation less than or equal to 3.5 g/dl (hr = 1.34; 95% ci, 1.01-1.78), planned average relative dose intensity greater than or equal to 80% (hr = 2.70; 95% ci, 1.47-4.98), baseline absolute neutrophil count less than 1500/mm3 (hr = 1.98; 95% ci, 1.28-3.06), and the presence of hepatic disease (hr = 2.18; 95% ci, 1.11-4.28). lack of early granulocyte colony-stimulating factor in cycles 1 and 2 was also associated with increased risk of hospitalization for febrile neutropenia, but this did not reach statistical significance. a composite risk score based on these potential risk factors effectively distinguished patients at greater risk of hospitalization for febrile neutropenia (p < 0.001), the majority of which were observed during the first cycle of chemotherapy.
Conclusions:
The data from the current study demonstrated that the risk of initial hospitalization for febrile neutropenia occured early in the course of chop-like chemotherapy. identified risk factors for febrile neutropenia hospitalization may facilitate the use of targeted supportive care.