Treatment of Hodgkin Lymphoma without G-CSF Does Not Increase the Risk of Febrile Neutropenia.
Notice bibliographique
Résumé
Abstract Abstract 2502 Poster Board II-479 Background: Patients with Hodgkin Lymphoma (HL) being treated with ABVD chemotherapy frequently develop neutropenia, though the complication of febrile neutropenia is relatively uncommon. In most cancer centres, including our own until recently, the presence of neutropenia on the planned day of chemotherapy administration (absolute neutrophil count (ANC) <1.5×109/L) often resulted in delays in chemotherapy administration and/or dose attenuation, plus the addition of G-CSF prophylaxis through all subsequent cycles of chemotherapy. G-CSF is costly and it can cause side effects such as bone pain. There is also some suggestion in the literature that G-CSF may increase the risk of bleomycin lung toxicity (BLT). Several retrospective studies have reported that full dose ABVD can be safely administered to patients without routine G-CSF support, regardless of the neutrophil count on the day of treatment. Based on this data, our centre decided to change the practice of routinely delaying chemotherapy and starting G-CSF prophylaxis in neutropenic patients, and to prospectively monitor the safety of this practice change. We present the results of our planned interim safety analysis. Methods: Newly diagnosed patients with HL with no bone marrow involvement and no significant co-morbidities were enrolled and followed prospectively throughout their treatment. ABVD chemotherapy was administered every two weeks without dose delay or attenuation and without the addition of G-CSF, regardless of the neutrophil count on the day of treatment. Dose reductions were permitted for non-hematological toxicities. G-CSF was added as secondary prophylaxis to all subsequent cycles in patients who developed febrile neutropenia. We also retrospectively reviewed the charts of patients with HL treated with ABVD at our centre from 2004-2007 (prior to practice change) and collected data on the incidence of neutropenia, febrile neutropenia, G-CSF use and BLT. Continuous variables were analysed using the Mann Whitney U test and dichotomous variables using Chi squared analysis. Results: Since September 2008, 17 patients have been enrolled in the study. No patients met criteria for exclusion. A total of 149 ‘doses' (half cycles) of ABVD have been administered so far. Table 1 shows demographic information on the prospective and retrospective patient populations, as well as rates of neutropenia, febrile neutropenia, and BLT. Almost all study patients (15/17, 88%) had documented neutropenia at some point during treatment, the majority (13 patients) as early as cycle 1B. Excluding cycle 1A, the median neutrophil count on day of treatment was 1.3×109/L. Half of the chemotherapy doses (74/149) were administered with an ANC <1.5×109/L; one third (52 doses) with grade 3/4 neutropenia. None of the chemotherapy was dose reduced (except for non-hematologic toxicity) and most of the treatments were given on time, with a median dose interval of 14 days. One patient developed BLT after cycle 4B. There was 1 episode of low risk febrile neutropenia occurring after cycle 3B in which no causative organism was identified. This patient received all subsequent chemotherapy with G-CSF prophylaxis with no further episodes of neutropenic fever. Conclusion: This interim analysis shows that ABVD chemotherapy can be safely administered to patients with HL without dose attenuation, delays or the routine use of G-CSF prophylaxis in the setting of neutropenia. This practice change resulted in a similar very low rate of febrile neutropenia (<1%), but significant reductions in cost and dose delay secondary to neutropenia. Disclosures: No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».