Factors for the optimal selection of granulocyte colony-stimulating factor preparations and predictors for R-CHOP dose reductions/delays among patients with non-Hodgkin B-cell lymphoma (STOP FN in NHL 2 subanalysis)

Defining primary refractory large B-cell lymphoma

ABSTRACT

Patients with large B-cell lymphoma (LBCL) that fail to achieve a complete response (CR) or who relapse early after anthracycline-containing immunochemotherapy (IC) have a poor prognosis and are commonly considered to have "primary refractory disease." However, different definitions of primary refractory disease are used in the literature and clinical practice. In this study, we examined variation in the time to relapse used to define refractory status and association with survival outcomes in patients with primary refractory LBCL in a single-center prospective cohort with validation in an independent multicenter cohort. Patients with newly diagnosed LBCL were enrolled in the Molecular Epidemiological Resource cohort (MER; N = 949) or the Lymphoma Epidemiology of Outcomes cohort (LEO; N = 2755) from September 2002 to May 2021. Primary refractory LBCL was defined as no response (stable disease [SD]) or progressive disease (PD) during, or by the end of, frontline (1L) IC (primary PD; PPD); partial response at end of treatment (EOT PR); or relapse within 3 to 12 months after achieving CR at EOT to 1L IC (early relapse). In the MER cohort, patients with PPD had inferior overall survival (OS; 2-year OS rate: 15% MER, 31% LEO) when compared with other subgroups considered in defining primary refractory disease, EOT PR (2-year OS rate: 38% MER, 50% LEO) and early relapse (2-year OS rate: 44% MER, 58% LEO). Among patients receiving 1L IC with curative intent, we identified that patients with PPD are the key subgroup with poor outcomes. We propose a definition of primary refractory LBCL as SD or PD during, or by the end of, 1L treatment.

G-CSF primary prophylaxis use and outcomes in patients receiving chemotherapy at intermediate risk for febrile neutropenia: a scoping review

INTRODUCTION

Febrile neutropenia (FN) is a major dose-limiting toxicity of myelosuppressive chemotherapy, and several patients receiving chemotherapy are at intermediate risk of developing FN. However, the guidelines remain less clear regarding the use of granulocyte colony-stimulating factors (G-CSFs) for this population and insights about real-world prophylaxis patterns and FN outcomes are needed.

AREAS COVERED

This scoping review summarizes the variability in real-world G-CSF prophylaxis treatment patterns, incidence of FN, and associated outcomes among patients receiving chemotherapy at intermediate risk of FN. G-CSF PP use varied across the included studies (N = 23). Overall, there was a trend for reduced FN incidence among patients who received G-CSF PP vs. those who did not. G-CSF PP was also associated with a lower incidence of FN-related dose delays and reductions and fewer hospitalization days. Gaps in the literature of real-world studies exist, particularly around incorporating FN risk factor assessment, patient-reported outcomes, and health economic outcomes.

EXPERT OPINION

Further studies are warranted to determine the impact of G-CSF PP use on clinical, quality of life, and economic outcomes in patients with intermediate FN risk, which could optimize care for this subgroup of patients, resulting in better population-based FN-related outcomes.