Optimizing Dose-Adjusted EPOCH Chemotherapy with Long-Acting Granulocyte Colony-Stimulating Factor During the COVID-19 Epidemic

Abstract

Introduction

Febrile neutropenia (FN) is a highly prevalent complication of chemotherapy. In this study, we aimed to evaluate the efficacy of polyethylene glycol recombinant granulocyte colony-stimulating factor (PEG-rhG-CSF) compared with short-acting rhG-CSF in the dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) regimen.

Patients and Methods

A total of 66 patients with newly diagnosed aggressive B-cell lymphomas who received the rituximab combined with DA-EPOCH regimen and G-CSF support after chemotherapy were included in this study, including 33 patients in the PEG-rhG-CSF group during coronavirus disease (COVID-19) epidemic and another 33 matched patients in short-acting rhG-CSF group as historic control.

Results

The incidence of FN and FN-related hospitalization was significantly lower in chemotherapy cycles using PEG-rhG-CSF than in those using short-acting rhG-CSF (FN incidence: 10.4% vs 20.2%, P=0.038; incidence of FN-related hospitalization: 1.7% vs 7.3%, P=0.042). Overall, the incidence of dose-escalation and dose-reduction of the DA-EPOCH regimen was similar between these two groups.

Conclusion

Our findings suggest that PEG-rhG-CSF as a substitute for short-acting rhG-CSF in the DA-EPOCH regimen significantly reduced the incidence of FN and FN-related hospitalization, while simplifying neutropenia management for both patients and healthcare providers.

Keywords:

• febrile neutropenia
• granulocyte colony-stimulating factor
• lymphoma
• chemotherapy

Ethical Approval

The study was done in accordance with the Declaration of Helsinki. The protocol was approved by our institutional review board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Disclosure

The authors declare that they have no conflict of interest.