Morrison, V.A., Weller, E.A., Habermann, T.M., Li, S., Fisher, R.I., Cheson, B.D., & Peterson, B.A. (2017). Patterns of growth factor usage and febrile neutropenia among older patients with diffuse large B-cell non-Hodgkin lymphoma treated with CHOP or R-CHOP: The Intergroup experience (CALGB 9793; ECOG-SWOG 4494). Leukemia and Lymphoma, 58, 1814–1822.

To describe GCSF use and incidence of febrile neutropenia in patients aged 60 years or older with diffuse large B-cell lymphoma receiving initial CHOP or R-CHOP therapy.

Patients enrolled on the United States Intergroup Trial (CALGB 9793/ECOGSWOG 4494) were randomized to CHOP or RCHOP chemotherapy for the initial treatment of diffuse large B-cell lymphoma. The protocol did not allow CSF use for the first cycle.  

If day 1 ANC was less than 1,500 cells/mm³, treatment was delayed a week. If FN occurred in the prior treatment cycle, cyclophosphamide and doxorubicin doses were reduced by 50% in the next cycle. These doses could be increased by 25% if the subsequent cycle was well tolerated, with no grade 3/4 hematologic toxicities.
Colony stimulating factor (CSF) could be used starting with second cycle to maintain dose intensity in event of neutropenic fever or dose reduction/delay.

• N = 520   
• AGE: 60 years or older
• MALES: 50%  
• FEMALES: 50%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Previously untreated diffuse large B-cell lymphoma
• OTHER KEY SAMPLE CHARACTERISTICS: Age greater than 60 years and receiving initial therapy with RCHOP or CHOP on the United States Intergroup Trial (CALGB 9793/ECOGSWOG 4494)

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: United States

• PHASE OF CARE: Active anti-tumor treatment
• APPLICATIONS: Elder care

Observational study

Data measured included the timeliness of chemotherapy administration (treatment delay), CSF use, reason for CSF use, febrile neutropenia, neutropenia, and chemotherapy dose reduction.

49% of patients received CSF during therapy. The median number of cycles for which CSF was used was three (range = 1-7) and the median duration of CSDF use was nine days. CSF was used to prevent chemotherapy dose reduction/dose delay in approximately 60% of patients, and for secondary prophylaxis in cycle(s) following FN hospitalization in one third of patients. Overall CSF was used during 16% of administered chemotherapy cycles. Significantly more patients were treated with CSF in later cycles of therapy. FN occurred in 41% of patients, and 38% of the episodes occurred in cycle 1.

For patients with diffuse large B-cell lymphoma who are 60 years of age and older who are receiving initial therapy with CHOP or RCHOP, CSFs helped maintain dose intensity and to prevent febrile neutropenia.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

CSF is recommended for patients with diffuse large B-cell lymphoma who are 60 years of age and older who are receiving initial therapy with CHOP or RCHOP to prevent febrile neutropenia and maintain dose intensity. This is consistent with current standard practice.