Risk of chemotherapy-induced neutropenic complications when treating patients with non-Hodgkin lymphoma

ABSTRACT

Introduction: Myelosuppression induced by cancer chemotherapy is associated with considerable morbidity and mortality. Febrile neutropenia (FN) represents an oncologic emergency requiring immediate evaluation and treatment. Resulting chemotherapy dose reductions or delays may compromise disease control and survival. While non-Hodgkin lymphoma (NHL) represents a potentially curable malignancy, there are limited data on the risk of neutropenic complications. This review represents a systematic search and evidence summary of neutropenic complications reported in randomized controlled trials (RCTs) published over the past decade in adults with NHL receiving myelosuppressive chemotherapy.

Areas covered: Data captured include the chemotherapy regimen and dosing, the type of NHL, sample size, myeloid growth factor (MGF) use, and myelosuppression including FN and severe neutropenia and infection.

Expert opinion: Rates of neutropenic complications for commonly utilized chemotherapy regimens vary considerably across studies with FN reported in only one-fourth of study arms. Further challenges in interpreting reported rates are the variable and inconsistent use of MGF support and little or no information on delivered chemotherapy dose intensity. Considerable change in regimens, study populations and reporting of neutropenic events as well as the use of MGF was observed over the decade of RCTs reported. Complete and accurate reporting of treatment-related toxicities in patients receiving cancer chemotherapy is essential in both clinical trials and clinical practice.

KEY WORDS:

• Lymphoma
• chemotherapy
• neutropenia
• infection
• febrile neutropenia

Article Highlights Box

• Chemotherapy-induced neutropenic complications are associated with considerable morbidity and mortality.

• Febrile neutropenia represents an oncologic emergency requiring immediate evaluation and treatment.

• This is a systematic search and evidence summary of neutropenic complications reported in randomized controlled trials published over the past decade in adults with NHL receiving myelosuppressive chemotherapy.

• Febrile neutropenia was reported in only one-quarter of study arms and the rates vary greatly across studies.

• Utilization of delivered dose intensity and use of myeloid growth factors are also rarely and inconsistently reported.

• Complete and accurate reporting of treatment-related toxicities is essential in clinical trials of cancer chemotherapy.

This box summarizes key points contained in the article.

Declaration of interest

GH Lyman is the Principal Investigator on a research grant to the Fred Hutchinson Cancer Research Center from Amgen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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