Contributions
Abstract: PB1443
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The R-CHOP chemotherapy protocol is the gold standard for the treatment of non-Hodgkin's B lymphomas due to its efficiency in terms of therapeutic response and survival. However, this therapeutic combination can cause a significant toxicity.
Aims
The aim of this work is to study the incidence and severity of acute toxicity after R-CHOP, to study predictive factors of hematological or extra-hematological complications after R-CHOP, and to estimate the overall survival and mortality rate associated with this protocol.
Methods
This is a sixteen-year retrospective study at the Clinical Hematology Department of the Military Hospital of Tunis. The clinical and biological data of 89 patients were collected and the study of the side effects of 551 R-CHOP type chemotherapy cycles were detailed. The total number was divided into 407 R-CHOP21 and 144 R-CHOP14 cycles.
Results
Hematological toxicity was observed in 92% of the cycles, with predominantly grade 1 anemia, thrombocytopenia and lymphopenia. Among the 63 (11.4%) cases of grade 4 neutropenia, 34 (6%) progressed to febrile neutropenia (FN) with only 3 during RCHOP14. Among the 65 patients who received RCHOP21, 15 had primary prophylaxis with granulocyte colony-stimulating factors (G-CSF), and among these patients, only 3 episodes of FN were described, while the total number of FN episodes during RCHOP21 was 31 (7.6% of the total cycles of RCHOP21). In univariate analysis, it was found that the presence of more than two comorbidities, a positive Charlson score, hypoalbuminemia, hemoglobin lower than 12 g/dl and neutrophil count less than 1500/mm3 at the pre-treatment assessment, lymphopenia less than 600/mm3, thrombocytopenia less than 100 000/mm3, lack of G-CSF prophylaxis, as well as the type of treatment received (RCHOP21), were predictive factors for the occurrence of febrile neutropenia. In multivariate analysis, significant risk factors for FN were hypoalbuminemia (p=0.01), neutrophil count less than 1500/mm3 on pre-chemotherapy workup (p=0.013), lymphopenia and thrombocytopenia (p < 0.0001 respectively). Neurological toxicity was seen predominantly (42.8%) at the end of the 5th cycle. An age over 60 was found to be an independent risk factor for neurological toxicity (p=0.005). Pulmonary, hepatic and renal toxicities were not significant. As for cardiac toxicity, it was observed in 4 patients, and resulted in a deadly heart failure in one case. Fifteen deaths were recorded in our study, including three toxic deaths. The overall survival was influenced by the absence of primary G-CSF prophylaxis (p=0.002), the presence of initial liver damage (p=0.001), and the occurrence of FN during the first cycle (p=0.013). The event-free survival was also correlated with the absence of primary G-CSF prophylaxis (p=0.005), the occurrence of FN during cycle 1 (p=0.039), and the presence of initial liver damage (p=0.001).
Conclusion
Our results confirms the efficiency of the R-CHOP protocol in terms of therapeutic response. However, an acute toxicity, essentially hematological and cardiac, was noted. Systematic G-CSF prophylaxis and close cardiac monitoring would therefore help reduce these adverse effects.
Keyword(s): Chemotherapy toxicity, Lymphoma
Abstract: PB1443
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The R-CHOP chemotherapy protocol is the gold standard for the treatment of non-Hodgkin's B lymphomas due to its efficiency in terms of therapeutic response and survival. However, this therapeutic combination can cause a significant toxicity.
Aims
The aim of this work is to study the incidence and severity of acute toxicity after R-CHOP, to study predictive factors of hematological or extra-hematological complications after R-CHOP, and to estimate the overall survival and mortality rate associated with this protocol.
Methods
This is a sixteen-year retrospective study at the Clinical Hematology Department of the Military Hospital of Tunis. The clinical and biological data of 89 patients were collected and the study of the side effects of 551 R-CHOP type chemotherapy cycles were detailed. The total number was divided into 407 R-CHOP21 and 144 R-CHOP14 cycles.
Results
Hematological toxicity was observed in 92% of the cycles, with predominantly grade 1 anemia, thrombocytopenia and lymphopenia. Among the 63 (11.4%) cases of grade 4 neutropenia, 34 (6%) progressed to febrile neutropenia (FN) with only 3 during RCHOP14. Among the 65 patients who received RCHOP21, 15 had primary prophylaxis with granulocyte colony-stimulating factors (G-CSF), and among these patients, only 3 episodes of FN were described, while the total number of FN episodes during RCHOP21 was 31 (7.6% of the total cycles of RCHOP21). In univariate analysis, it was found that the presence of more than two comorbidities, a positive Charlson score, hypoalbuminemia, hemoglobin lower than 12 g/dl and neutrophil count less than 1500/mm3 at the pre-treatment assessment, lymphopenia less than 600/mm3, thrombocytopenia less than 100 000/mm3, lack of G-CSF prophylaxis, as well as the type of treatment received (RCHOP21), were predictive factors for the occurrence of febrile neutropenia. In multivariate analysis, significant risk factors for FN were hypoalbuminemia (p=0.01), neutrophil count less than 1500/mm3 on pre-chemotherapy workup (p=0.013), lymphopenia and thrombocytopenia (p < 0.0001 respectively). Neurological toxicity was seen predominantly (42.8%) at the end of the 5th cycle. An age over 60 was found to be an independent risk factor for neurological toxicity (p=0.005). Pulmonary, hepatic and renal toxicities were not significant. As for cardiac toxicity, it was observed in 4 patients, and resulted in a deadly heart failure in one case. Fifteen deaths were recorded in our study, including three toxic deaths. The overall survival was influenced by the absence of primary G-CSF prophylaxis (p=0.002), the presence of initial liver damage (p=0.001), and the occurrence of FN during the first cycle (p=0.013). The event-free survival was also correlated with the absence of primary G-CSF prophylaxis (p=0.005), the occurrence of FN during cycle 1 (p=0.039), and the presence of initial liver damage (p=0.001).
Conclusion
Our results confirms the efficiency of the R-CHOP protocol in terms of therapeutic response. However, an acute toxicity, essentially hematological and cardiac, was noted. Systematic G-CSF prophylaxis and close cardiac monitoring would therefore help reduce these adverse effects.
Keyword(s): Chemotherapy toxicity, Lymphoma