Real-World Impact of Prophylactic Pegfilgrastim in Diffuse Large B-Cell Lymphoma (DLBCL) Patients Receiving Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) With or Without Rituximab Chemotherapy in Korea

In this single-center, retrospective cohort study, electronic medical records were used to examine the real-world impact of prophylactic pegfilgrastim (PP) in patients with diffuse large B-cell lymphoma (DLBCL) receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy.

The primary end point of this study was the comparison of febrile neutropenia and neutropenia events at first cycle. The secondary end point was the comparison of febrile neutropenia and neutropenia events across all cycles. Patients were randomized into 2 groups: the PP group and the non-PP group. Baseline characteristics were comparable across treatment groups.

A total of 160 patients were enrolled in this study at the Asan Medical Center in Korea. At cycle 1, the incidence of febrile neutropenia was significantly lower in patients who received PP versus patients who did not (6 PP cases [7.8%] vs 16 non-PP cases [19.3%]; P = 0.035). The rates of grades 3 and 4 neutropenia were significantly lower in the PP group (48.1%) versus patients who did not receive PP (67.5%; P = 0.013). There were statistically significant differences by cycle, but neutropenia incidence of the PP group trended.

Across all treatment cycles, the PP group reported lower incidence of grades 3 and 4 neutropenia but were only statistically significant at cycles 1 (P <0.05), 5 (P <0.01), and 6 (P <0.01). In a multiple logistic regression, hemoglobin <12 g/dL, platelets <100 k/mm3, and serum creatinine ≥1.4 mg/dL were associated with febrile neutropenia occurrence.

In conclusion, PP was associated with fewer neutropenic events in patients receiving CHOP with or without rituximab for DLBCL, regardless of cycles. The data report that it is reasonable to utilize PP during all chemotherapy cycles, especially cycle 1, as there is often a higher incidence of neutropenic events. Consideration should be given to patient-related risk factors when determining the appropriate use of pegfilgrastim.

Lee M. Abstract presented at ASHP Midyear Clinical Meeting. Las Vegas, NV; December 2016. Abstract 196544.

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