Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients
Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients
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DOI：
10.1007/s12185-021-03118-6
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发表时间：
2021-03-18
影响因子：
2.1
通讯作者：
Kurokawa, Mineo
中科院分区：
文献类型：
--
作者：
Ise, Masataka;Matsuda, Kensuke;Kurokawa, Mineo
培非格司亭在第一个化疗周期的长期效果尚不清楚。我们回顾性地确定了114例年龄≥ 70岁的弥漫性大B细胞淋巴瘤患者，他们在我们的机构接受了利妥昔单抗-环磷酰胺-阿霉素-长春新碱-泼尼松龙（R-CHOP）方案。26例患者接受培非格司亭（培非格司亭组）;在88例计划在中性粒细胞计数降低时接受常规粒细胞集落刺激因子（G-CSF）的患者中（中性粒细胞校正G组），57例最终接受常规G-CSF。在R-CHOP的第一个周期内，培非格司亭组中发热性中性粒细胞减少的发生率低于中性粒细胞调整的G组（0% vs. 18%，p = 0.020）。在所有周期中，培非格司亭组中表现出持续相对剂量强度（>= 80%）的患者比例高于中性校正G组（25% vs. 4.0%，p = 0.008）。培非格司亭组在第二个周期接受减量治疗的患者比例低于中性调整G组（0% vs. 10%，p = 0.116）。尽管差异不显著，但培非格司亭组的无进展生存期和总生存期高于中性校正G组。在R-CHOP的第一个周期使用培非格司亭充分预防发热性中性粒细胞减少可能有助于避免所有周期的剂量强度降低。
The long-term effects of pegfilgrastim administered in the first cycle of chemotherapy in day-to-day practice remain unclear. We retrospectively identified 114 patients aged >= 70 years with diffuse large B-cell lymphoma who received a rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone (R-CHOP) regimen in our institution. Twenty-six patients received pegfilgrastim (pegfilgrastim group); of the 88 patients scheduled to receive conventional granulocyte-colony stimulating factor (G-CSF) when their neutrophil count decreased (neut-adjusted-G group), conventional G-CSF was ultimately administered to 57. During the first cycle of R-CHOP, the incidence of febrile neutropenia was lower in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 18%, p = 0.020). Throughout all cycles, a higher proportion of patients exhibited sustained relative dose intensity (>= 80%) in the pegfilgrastim group than in the neut-adjusted-G group (25% vs. 4.0%, p = 0.008). A lower proportion of patients received a reduced dose in the second cycle in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 10%, p = 0.116). Although the differences were not significant, the pegfilgrastim group showed higher progression-free survival and overall survival than the neut-adjusted-G group. Adequate prevention of febrile neutropenia using pegfilgrastim during the first cycle of R-CHOP may contribute to avoidance of dose intensity reduction in all cycles.