DESCRIPTION OF LATE ONSET NEUTROPENIA IN PATIENTS TREATED WITH BENDAMUSTINE PLUS RITUXIMAB
(Abstract release date: 05/19/16)
EHA Library. Verriere B. 06/09/16; 134763; PB1863
Dr. Benjamin Verriere
Contributions
Contributions
Abstract
Abstract: PB1863
Type: Publication Only
Background
Bendamustine (B) is an alkylating drug indicated for the treatment of patients with chronic lymphoid leukemia (CLL) who are not eligible to Fludarabine. In addition, Rummel et al. (Lancet 2013) described B associated with Rituximab (R) as a therapeutic alternative to R-CHOP in follicular and other indolent lymphomas. Although hematoxicity of B is largely described in the literature, both late onset neutropenia and lymphopenia occurring after the last cycle of immunochemotherapy are not described.
Aims
We report a cohort of patients treated with B+R showing late onset neutropenia after the end of lymphoma treatment.
Methods
This is an observational retrospective study (Anticancer Center Antoine-Lacassagne, Nice and General Hospital, Antibes, France) including patients treated from January 2009 to June 2015. The study included patients with CLL and indolent NHL (follicular, mantle cell and marginal zone) having received at least one cycle of the association of R (375mg/m²) and B (70 or 90mg/m²x 2 D) as part of their first or second line treatment. Assessment of hematotoxicity was performed according to CTCAE v4.0. We excluded patients with neutropenia preexisting to immunochemotherapy or relapsing within 3 months after the end of induction treatment.
Results
287 patients received one to six cycles of B+R. We noted a total of 83 episodes of late onset of neutropenia (51 grade I/II, 32 grade III/IV) in 36 patients (follow-up 12 months). The characteristics of those 36 patients are the following: sex ratio (M/F) 0.61; median age 73 years (48 to 93); 94% PS 0/1; 36% CLL, 42% follicular lymphomas (FL), 14% mantle cells lymphomas (MCL) and 8% other indolent lymphomas (including marginal lymphoma). Dose intensity is 100% for B and R with an average of 5 cycles (92% of patients received more than 4 cycles of R+B). Among 15 patients with FL, 13 received a maintenance treatment after B+R, with R monotherapy (mean number of cycles: 5.9) that was interrupted in 8 for at least grade II neutropenia. Grade III/IV neutropenia occurred in 9 patients (including 2 patients with FL treated with R maintenance). There was no event of febrile neutropenia within the study period. Four patients had ongoing grade I/II neutropenia one year after the last cycle of immunochemotherapy. Bone marrow smears weren’t performed systematically in our patients (n=13).
Conclusion
In our retrospective study we describe late onset neutropenia in lymphoma patients treated with R+B. The incidence reported is 12,5% (11% for grade ≥ 3). Although we did not observe febrile neutropenia in those patients, late onset neutropenia directly impacts on the strategy of lymphoma treatment especially in FL patients receiving R maintenance. We cannot determine separately the impact of R or B for late onset neutropenia but it is hypothesized that the association of R+B increases late onset neutropenia when compared to each treatment alone. Exploratory sub-group analysis is under way. Considering those results, we suggest a close hematologic follow-up of patients treated with R+B immunochemotherapy in order to identify and treat late onset neutropenia.
Session topic: E-poster
Keyword(s): Bendamustine, Late effects, Neutropenia, Rituximab
Type: Publication Only
Background
Bendamustine (B) is an alkylating drug indicated for the treatment of patients with chronic lymphoid leukemia (CLL) who are not eligible to Fludarabine. In addition, Rummel et al. (Lancet 2013) described B associated with Rituximab (R) as a therapeutic alternative to R-CHOP in follicular and other indolent lymphomas. Although hematoxicity of B is largely described in the literature, both late onset neutropenia and lymphopenia occurring after the last cycle of immunochemotherapy are not described.
Aims
We report a cohort of patients treated with B+R showing late onset neutropenia after the end of lymphoma treatment.
Methods
This is an observational retrospective study (Anticancer Center Antoine-Lacassagne, Nice and General Hospital, Antibes, France) including patients treated from January 2009 to June 2015. The study included patients with CLL and indolent NHL (follicular, mantle cell and marginal zone) having received at least one cycle of the association of R (375mg/m²) and B (70 or 90mg/m²x 2 D) as part of their first or second line treatment. Assessment of hematotoxicity was performed according to CTCAE v4.0. We excluded patients with neutropenia preexisting to immunochemotherapy or relapsing within 3 months after the end of induction treatment.
Results
287 patients received one to six cycles of B+R. We noted a total of 83 episodes of late onset of neutropenia (51 grade I/II, 32 grade III/IV) in 36 patients (follow-up 12 months). The characteristics of those 36 patients are the following: sex ratio (M/F) 0.61; median age 73 years (48 to 93); 94% PS 0/1; 36% CLL, 42% follicular lymphomas (FL), 14% mantle cells lymphomas (MCL) and 8% other indolent lymphomas (including marginal lymphoma). Dose intensity is 100% for B and R with an average of 5 cycles (92% of patients received more than 4 cycles of R+B). Among 15 patients with FL, 13 received a maintenance treatment after B+R, with R monotherapy (mean number of cycles: 5.9) that was interrupted in 8 for at least grade II neutropenia. Grade III/IV neutropenia occurred in 9 patients (including 2 patients with FL treated with R maintenance). There was no event of febrile neutropenia within the study period. Four patients had ongoing grade I/II neutropenia one year after the last cycle of immunochemotherapy. Bone marrow smears weren’t performed systematically in our patients (n=13).
Conclusion
In our retrospective study we describe late onset neutropenia in lymphoma patients treated with R+B. The incidence reported is 12,5% (11% for grade ≥ 3). Although we did not observe febrile neutropenia in those patients, late onset neutropenia directly impacts on the strategy of lymphoma treatment especially in FL patients receiving R maintenance. We cannot determine separately the impact of R or B for late onset neutropenia but it is hypothesized that the association of R+B increases late onset neutropenia when compared to each treatment alone. Exploratory sub-group analysis is under way. Considering those results, we suggest a close hematologic follow-up of patients treated with R+B immunochemotherapy in order to identify and treat late onset neutropenia.
Session topic: E-poster
Keyword(s): Bendamustine, Late effects, Neutropenia, Rituximab
Abstract: PB1863
Type: Publication Only
Background
Bendamustine (B) is an alkylating drug indicated for the treatment of patients with chronic lymphoid leukemia (CLL) who are not eligible to Fludarabine. In addition, Rummel et al. (Lancet 2013) described B associated with Rituximab (R) as a therapeutic alternative to R-CHOP in follicular and other indolent lymphomas. Although hematoxicity of B is largely described in the literature, both late onset neutropenia and lymphopenia occurring after the last cycle of immunochemotherapy are not described.
Aims
We report a cohort of patients treated with B+R showing late onset neutropenia after the end of lymphoma treatment.
Methods
This is an observational retrospective study (Anticancer Center Antoine-Lacassagne, Nice and General Hospital, Antibes, France) including patients treated from January 2009 to June 2015. The study included patients with CLL and indolent NHL (follicular, mantle cell and marginal zone) having received at least one cycle of the association of R (375mg/m²) and B (70 or 90mg/m²x 2 D) as part of their first or second line treatment. Assessment of hematotoxicity was performed according to CTCAE v4.0. We excluded patients with neutropenia preexisting to immunochemotherapy or relapsing within 3 months after the end of induction treatment.
Results
287 patients received one to six cycles of B+R. We noted a total of 83 episodes of late onset of neutropenia (51 grade I/II, 32 grade III/IV) in 36 patients (follow-up 12 months). The characteristics of those 36 patients are the following: sex ratio (M/F) 0.61; median age 73 years (48 to 93); 94% PS 0/1; 36% CLL, 42% follicular lymphomas (FL), 14% mantle cells lymphomas (MCL) and 8% other indolent lymphomas (including marginal lymphoma). Dose intensity is 100% for B and R with an average of 5 cycles (92% of patients received more than 4 cycles of R+B). Among 15 patients with FL, 13 received a maintenance treatment after B+R, with R monotherapy (mean number of cycles: 5.9) that was interrupted in 8 for at least grade II neutropenia. Grade III/IV neutropenia occurred in 9 patients (including 2 patients with FL treated with R maintenance). There was no event of febrile neutropenia within the study period. Four patients had ongoing grade I/II neutropenia one year after the last cycle of immunochemotherapy. Bone marrow smears weren’t performed systematically in our patients (n=13).
Conclusion
In our retrospective study we describe late onset neutropenia in lymphoma patients treated with R+B. The incidence reported is 12,5% (11% for grade ≥ 3). Although we did not observe febrile neutropenia in those patients, late onset neutropenia directly impacts on the strategy of lymphoma treatment especially in FL patients receiving R maintenance. We cannot determine separately the impact of R or B for late onset neutropenia but it is hypothesized that the association of R+B increases late onset neutropenia when compared to each treatment alone. Exploratory sub-group analysis is under way. Considering those results, we suggest a close hematologic follow-up of patients treated with R+B immunochemotherapy in order to identify and treat late onset neutropenia.
Session topic: E-poster
Keyword(s): Bendamustine, Late effects, Neutropenia, Rituximab
Type: Publication Only
Background
Bendamustine (B) is an alkylating drug indicated for the treatment of patients with chronic lymphoid leukemia (CLL) who are not eligible to Fludarabine. In addition, Rummel et al. (Lancet 2013) described B associated with Rituximab (R) as a therapeutic alternative to R-CHOP in follicular and other indolent lymphomas. Although hematoxicity of B is largely described in the literature, both late onset neutropenia and lymphopenia occurring after the last cycle of immunochemotherapy are not described.
Aims
We report a cohort of patients treated with B+R showing late onset neutropenia after the end of lymphoma treatment.
Methods
This is an observational retrospective study (Anticancer Center Antoine-Lacassagne, Nice and General Hospital, Antibes, France) including patients treated from January 2009 to June 2015. The study included patients with CLL and indolent NHL (follicular, mantle cell and marginal zone) having received at least one cycle of the association of R (375mg/m²) and B (70 or 90mg/m²x 2 D) as part of their first or second line treatment. Assessment of hematotoxicity was performed according to CTCAE v4.0. We excluded patients with neutropenia preexisting to immunochemotherapy or relapsing within 3 months after the end of induction treatment.
Results
287 patients received one to six cycles of B+R. We noted a total of 83 episodes of late onset of neutropenia (51 grade I/II, 32 grade III/IV) in 36 patients (follow-up 12 months). The characteristics of those 36 patients are the following: sex ratio (M/F) 0.61; median age 73 years (48 to 93); 94% PS 0/1; 36% CLL, 42% follicular lymphomas (FL), 14% mantle cells lymphomas (MCL) and 8% other indolent lymphomas (including marginal lymphoma). Dose intensity is 100% for B and R with an average of 5 cycles (92% of patients received more than 4 cycles of R+B). Among 15 patients with FL, 13 received a maintenance treatment after B+R, with R monotherapy (mean number of cycles: 5.9) that was interrupted in 8 for at least grade II neutropenia. Grade III/IV neutropenia occurred in 9 patients (including 2 patients with FL treated with R maintenance). There was no event of febrile neutropenia within the study period. Four patients had ongoing grade I/II neutropenia one year after the last cycle of immunochemotherapy. Bone marrow smears weren’t performed systematically in our patients (n=13).
Conclusion
In our retrospective study we describe late onset neutropenia in lymphoma patients treated with R+B. The incidence reported is 12,5% (11% for grade ≥ 3). Although we did not observe febrile neutropenia in those patients, late onset neutropenia directly impacts on the strategy of lymphoma treatment especially in FL patients receiving R maintenance. We cannot determine separately the impact of R or B for late onset neutropenia but it is hypothesized that the association of R+B increases late onset neutropenia when compared to each treatment alone. Exploratory sub-group analysis is under way. Considering those results, we suggest a close hematologic follow-up of patients treated with R+B immunochemotherapy in order to identify and treat late onset neutropenia.
Session topic: E-poster
Keyword(s): Bendamustine, Late effects, Neutropenia, Rituximab
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