Cheng, C., Gallagher, E.M., Yeh, J.Y., & Earl, M.A. (2014). Rates of febrile neutropenia with pegfilgrastim on same day versus next day of CHOP with or without rituximab. Anti-Cancer Drugs, 25, 964–969. 

To compare the rate of febrile neutropenia and neutropenia grade 4 among patients receiving pegfilgrastim on the same day of chemotherapy and after 24 hours of the chemotherapy administration

A retrospective, single-center, non-randomized, cohort study was conducted that includes the evaluation of the eligible patient’s chart selected via an institutional electronic device. Patients should be 18 years and older. They have conducted this study from May 2007 to January 2013. In this study, researchers reviewed the administration of 6 mg of pegfilgrastim in patients on the same day of chemotherapy (day 1) or on day 2 or beyond (up to day 8) of CHOP chemotherapy with or without rituximab every three weeks for a total of eight cycles. The researchers highlighted the potential risk factors contributing to febrile neutropenia. The febrile neutropenia criteria includes temperature of at least 38 C and ANC < 500cells/mm3. 

• N = 141  
• AGE = 18 years and older
• KEY DISEASE CHARACTERISTICS: Non-Hodgkin lymphoma

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: United states of America

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care

Retrospective, non-randomized, cohort study was conducted that contains chart review through institution electronic records.

• Fisher exact test
• SPSS software

Patients who received pegfilgrastim on the same day of chemotherapy had the highest incidence of febrile neutropenia (9.4%) compared to those who received the drug on day 1 or beyond (5.1%), showing a significant difference among both groups. In addition, the highest rate of dose reduction scenario was found in the day 1 group as compared to the day 2 and beyond  group (51.7% versus 40%). On the contrary, hospital stay duration and ICU admissions were high in the day 2 or beyond group versus the day 1 group (four admissions versus one admission).

The incidences of febrile neutropenia was less among the day 2 or beyond group of R-CHOP or CHOP.

• Baseline sample/group differences of import
• Key sample group differences that could influence results
• Measurement validity/reliability questionable 
• Findings not generalizable
• Time and duration of grade 4 neutropenia was not cleared, chemotherapy regimens were not standardized, and doses and cycles also differed.
• The type of infection was not clarified.

Additional studies need to be conducted for more accurate and reliable results.