Contributions
Abstract: PB2044
Type: Publication Only
Background
Maintenance of dose intensity in patients with a potentially curable disease, such as diffuse large B-cell lymphoma (DLBCL), who are treated with chemotherapy, such as R-CHOP (rituximab, doxorubicin, cyclophosphamide, vincristine, prednisolone), is very important. We conducted a nationwide questionnaire survey to see how DLBCL patients are treated by Japanese oncologists, and reported a part of the findings at the 15th Japanese Society of Medical Oncology (JSMO) annual meeting (Kobe, 2017), showing that the dose of R-CHOP therapy was easily reduced (<65 years old: 16.4%; ≥65 years old: 44.3%). One of the reasons for dose reduction was bone marrow suppression and febrile neutropenia (FN). The results of further analysis of FN are reported here in detail.
Aims
To survey Japanese real-world FN treatment and the prophylactic use of granulocyte-colony stimulating factor (G-CSF), oral anti-bacterials, anti-fungals, drugs against herpes simplex, and sulfamethoxazole-trimethoprim during curative treatment using R-CHOP therapy for patients with DLBCL.
Methods
The FN Study Group of the Japanese Association of Supportive Care in Cancer (JASCC) designed a questionnaire on FN during R-CHOP therapy, which consists of 65 questions addressing the management of DLBCL in different practice settings. The survey was conducted from July 25 to August 22, 2016. JSMO members were requested to answer the questions on an online survey (SurveyMonkey.com), and the results were collected and analyzed.
Results
The survey was answered by 336 (4%) of the 8,158 JSMO members. Accordingly, 93.1% and 54.7% of respondents said they would take blood cultures before the start of anti-bacterial agents for inpatients and outpatients, respectively. Primary G-CSF prophylaxis among the non-elderly (<65 years old) is used by 23.6% of respondents to prevent FN in inpatients and by 26.8% for outpatients. It is routinely used for elderly (≥65 years old) patients by 39.9% of respondents for inpatients and by 45.3% for outpatients. The most commonly used antimicrobials for FN at outpatient clinics are oral new quinolones (66.8%), while inpatient FN is treated using intravenous infusion of 3rd generation or 4th generation cephalosporins (76.8%). Prophylactic use of oral anti-bacterials, anti-fungals, drugs against herpes simplex, and sulfamethoxazole-trimethoprim to prevent development of FN, herpes simplex infection, and Pneumocystis jirovecii pneumonia was reported by 12.2%, 18.2%, 3.7%, and 67.7% of the respondents, respectively. Only 10.2% of respondents use Multinational Association of Supportive Care in Cancer score as a reference to estimate FN risk, while 93.7% of them are fully aware of JSMO FN guidelines and 73.2% of them treat FN patients accordingly.
Conclusion
Although the respondents’ rate of adherence to the JSMO FN guidelines for treatment of FN is relatively high, primary prophylactic use of G-CSF is low, especially for elderly (≥65 years old) patients. It is suggested that appropriate G-CSF use would substantially reduce FN further, allowing maintenance of relative dose intensity of R-CHOP therapy and improving the treatment outcomes of patients with DLBCL.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): CHOP, DLBCL, Febrile neutropenia, G-CSF
Abstract: PB2044
Type: Publication Only
Background
Maintenance of dose intensity in patients with a potentially curable disease, such as diffuse large B-cell lymphoma (DLBCL), who are treated with chemotherapy, such as R-CHOP (rituximab, doxorubicin, cyclophosphamide, vincristine, prednisolone), is very important. We conducted a nationwide questionnaire survey to see how DLBCL patients are treated by Japanese oncologists, and reported a part of the findings at the 15th Japanese Society of Medical Oncology (JSMO) annual meeting (Kobe, 2017), showing that the dose of R-CHOP therapy was easily reduced (<65 years old: 16.4%; ≥65 years old: 44.3%). One of the reasons for dose reduction was bone marrow suppression and febrile neutropenia (FN). The results of further analysis of FN are reported here in detail.
Aims
To survey Japanese real-world FN treatment and the prophylactic use of granulocyte-colony stimulating factor (G-CSF), oral anti-bacterials, anti-fungals, drugs against herpes simplex, and sulfamethoxazole-trimethoprim during curative treatment using R-CHOP therapy for patients with DLBCL.
Methods
The FN Study Group of the Japanese Association of Supportive Care in Cancer (JASCC) designed a questionnaire on FN during R-CHOP therapy, which consists of 65 questions addressing the management of DLBCL in different practice settings. The survey was conducted from July 25 to August 22, 2016. JSMO members were requested to answer the questions on an online survey (SurveyMonkey.com), and the results were collected and analyzed.
Results
The survey was answered by 336 (4%) of the 8,158 JSMO members. Accordingly, 93.1% and 54.7% of respondents said they would take blood cultures before the start of anti-bacterial agents for inpatients and outpatients, respectively. Primary G-CSF prophylaxis among the non-elderly (<65 years old) is used by 23.6% of respondents to prevent FN in inpatients and by 26.8% for outpatients. It is routinely used for elderly (≥65 years old) patients by 39.9% of respondents for inpatients and by 45.3% for outpatients. The most commonly used antimicrobials for FN at outpatient clinics are oral new quinolones (66.8%), while inpatient FN is treated using intravenous infusion of 3rd generation or 4th generation cephalosporins (76.8%). Prophylactic use of oral anti-bacterials, anti-fungals, drugs against herpes simplex, and sulfamethoxazole-trimethoprim to prevent development of FN, herpes simplex infection, and Pneumocystis jirovecii pneumonia was reported by 12.2%, 18.2%, 3.7%, and 67.7% of the respondents, respectively. Only 10.2% of respondents use Multinational Association of Supportive Care in Cancer score as a reference to estimate FN risk, while 93.7% of them are fully aware of JSMO FN guidelines and 73.2% of them treat FN patients accordingly.
Conclusion
Although the respondents’ rate of adherence to the JSMO FN guidelines for treatment of FN is relatively high, primary prophylactic use of G-CSF is low, especially for elderly (≥65 years old) patients. It is suggested that appropriate G-CSF use would substantially reduce FN further, allowing maintenance of relative dose intensity of R-CHOP therapy and improving the treatment outcomes of patients with DLBCL.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): CHOP, DLBCL, Febrile neutropenia, G-CSF