Changing patterns of chemotherapy relative dose intensity and supportive care for aggressive B-cell non-Hodgkin lymphoma

Abstract

Maintaining high relative dose intensity (RDI) is associated with improved outcomes, especially in patients with aggressive B-cell non-Hodgkin lymphoma (NHL). To evaluate changes in practice, we examined RDI, chemotherapy treatment patterns, dose delays and reductions, neutropenia and related consequences, and supportive care in 500 patients with aggressive B-cell NHL treated between 2006–2009. We then compared the results to a previous study of patients treated between 1993–2001. Relative to the previous study, rituximab was a common addition to CHOP-21 (91% vs. 3%), more patients received an RDI ≥ 85% (68% vs. 52%), and fewer patients experienced dose reductions (21% vs. 35%), though incidences of dose delays were similar (26% vs. 23%). Incidences of febrile neutropenia (FN; 12% vs. 21%) and FN-related hospitalizations (10% vs. 16%) were lower. Finally, more patients received primary prophylaxis with colony-stimulating factors (75% vs. 12%). Together, these results illustrate evolving practice patterns for patients with aggressive B-cell NHL.

Keywords::

• Chemotherapy
• granulocyte colony-stimulating factor
• lymphoma
• neutropenia
• non-Hodgkin

Acknowledgements

The authors thank Greg Valin (programmer), Sharon Hunter, and Sejal Badre (biostatisticians), and Natasha Gicanov and Paul Chang (study managers) for their contributions to this manuscript. Dr Lyman is the principal investigator of a research grant to the Fred Hutchinson Cancer Research Center from Amgen in support of the ANC Study Group. Drs Crawford and Dale have received research funding from and are on an advisory board of Amgen Inc. Dr Tomita and is an employee of and stockholder in Amgen Inc. Dr Whittaker is a former employee of Amgen Inc. and owns stock in Amgen Inc. No other conflicts are noted. Research support for this study was provided by Amgen Inc. Kerri Hebard-Massey and Micah Robinson (Amgen Inc.) provided medical writing support.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online.

Supplementary material available online

Supplementary Tables I and II to be found online www.tandfonline.com/ilal