Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Granulocytopenic fever (GCPF) associated with CHOP chemotherapy for intermediate grade non-Hodgkin's lymphoma (IGL); implications for the use of hematopoietic growth factors (HGF) (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 13:A1474 1994. Unique Identifier : AIDSLINE ICDB/94601468 Rigden J; Gonin R; Nichols CR; Indiana University School of Medicine, Indianapolis, IN 46202
Abstract:
While Phase II trials suggested a role for dose intensive treatments in IGL, randomized comparisons have suggested that CHOP represents standard treatment (Fisher, NEJM 328(14):1002-6, 1993). Despite two decades of study, clinical aspects of CHOP treatment are not completely defined. In particular, the incidence of GCPF is not well established and the therapeutic impact of modest dose reductions in the management of GCPF is unknown. These issues are of particular importance in an era when routine use of HGF has been suggested in this clinical setting. 137 consecutive patients (pts) with IGL treated with CHOP were reviewed. Of these, 42 pts (31%) had GCPF (fever greater than 101, AGC less than 500). Median hospital stay was 6 days (range 0-60). Three pts (2%) died of causes related to GCPF. GCPF was managed with a 25% dose reduction in the cyclophosphamide and doxorubicin in subsequent cycles. Despite having somewhat higher stage, advanced age and lower KPS, continuous complete remission was comparable in those requiring dose reduction (45%, median f/u 37 mo) versus those who did not (42%, median f/u 39 mo). With statistical analyses, dichotomous subgroups for age, KPS, stage, recent surgery, AIDS, and the presence of an intraluminal device were created. Univariate analyses were conducted (Fisher's exact test) to determine possible factors associated with GCPF. These were KPS (cutpoint 55%) (p less than 0.001), AIDS (p less than 0.001), and the presence of an intraluminal device (p less than 0.01). A significant association between an intraluminal device and KPS exist (p less than 0.01). Separate reports suggest that an incidence of GCPF of 40% represents the cutoff point where the use of prophylactic HGF is cost effective (Lyman, JNCI 85(6):488-93, 1993). We conclude that the incidence of GCPF of 31% in patients receiving CHOP chemotherapy for IGL is not sufficient to justify the routine application of HGF in all patients and that risk profiles can be developed that may rationally identify patients at especially high risk for GCPF. Furthermore, death from GCPF is very uncommon and judicious dose reduction for patients experiencing GCPF is not associated with diminished therapeutic effect.
Keywords: Age Factors Agranulocytosis/*CHEMICALLY INDUCED/*THERAPY Antineoplastic Agents, Combined/*ADVERSE EFFECTS Comparative Study Cyclophosphamide/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Doxorubicin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Hematopoietic Cell Growth Factors/*THERAPEUTIC USE Human Length of Stay Lymphoma, Non-Hodgkin's/*DRUG THERAPY/PATHOLOGY/SURGERY Prednisone/ADMINISTRATION & DOSAGE Vincristine/ADMINISTRATION & DOSAGE ABSTRACT
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
