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KMID : 0939920220540041268
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대한암학회지
2022 Volume.54 No. 4 p.1268 ~ p.1277
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Pegfilgrastim Prophylaxis Is Effective in the Prevention of Febrile Neutropenia and Reduces Mortality in Patients Aged ≥ 75 Years with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Cohort Study
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Jeong Seong-Hyun
Kim Seok-Jin
Yoon Dok-Hyun
Park Yong
Kang Hye-Jin
Koh Young-Il
Lee Gyeong-Won
Lee Won-Sik
Yang Deok-Hwan
Do Young-Rok
Kim Min-Kyoung
Yoo Kwai-Han
Choi Yoon-Seok
Yun Hwan-Jung
Yi Jun-Ho
Jo Jae-Cheol
Eom Hyeon-Seok
Kwak Jae-Yong
Shin Ho-Jin
Park Byeong-Bae
Hyun Shin-Young
Yi Seong-Yoon
Kwon Ji-Hyun
Oh Sung-Yong
Kim Hyo-Jung
Sohn Byeong-Seok
Won Jong-Ho
Kim Se-Hyung
Lee Ho-Sup
Suh Cheol-Won
Kim Won-Seog
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Abstract
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Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP).
Materials and Methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485).
Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p < 0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p < 0.001). Dose delay was less common (≥ 3 days: 18.1% vs. 23.7%, p=0.015; ≥ 5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥ 75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047).
Conclusion: Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥ 75 years.
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KEYWORD
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Pegfilgrastim, Prophylaxis, Diffuse large B-cell lymphoma
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