290P - Use of PEG G-CSF is associated with decreased myelotoxicity in dexrazoxane-used aggressive non-Hodgkin lymphoma patients

Background

Dexrazoxane (DXZ) is indicated as a cardioprotective agent for elderly aggressive lymphoma receiving doxorubicin. Several studies reported an apparent increase in the severity of myelosuppression when dexrazoxane was used. Prophylactic use of pegylated granulocyte colony stimulating factor (PEG G-CSF) is known to reduce the incidence of both neutropenia and febrile neutropenia. We conducted a retrospective study to evaluate prophylactic effect of PEG G-CSF in elderly aggressive lymphoma treated with CHOP-based regimen and cardioprotective dexrazoxane.

Methods

We retrospectively analyzed hematological toxicity data from 263 consecutive aggressive lymphoma patients who received a CHOP-based regimen between February 2010 and December 2021. Of these, 68 received dexrazoxane concurrently with the CHOP-based treatment. The differences between incidence of any of the explored outcomes were assessed according to the Fisher exact test.

Results

The median age at diagnosis was 77 (range; 70-87) year-old. Fifty-two patients (76.4%) were diagnosed with diffuse large B-cell lymphoma and treated with R-CHOP therapy. Bone marrow involvement was observed in seven patients (10.3%). Dose reduction (DR) was performed in all patients, as follows: 20% DR in 14 patients, 25% DR in 36 patients, 30% DR in 14 patients, and 40% DR in 4 patients. Treatment-related mortality occurred in 16 patients (23.5%). Grade III/IV neutropenia was developed with an incidence of 25.2% in the patients. Febrile neutropenia developed in 17 patients (25%) with an overall incidence of 8.0% (32/424 cycles) in the cycles. Compared with the non-PEG G-CSF group, PEG G-CSF treatment was associated with significantly lower rate of grade 3/4 hematological toxicities; leukopenia (66.5% vs. 10.7%; P=0.0001), neutropenia (69.6% vs. 16.1%; P=0.0001), febrile neutropenia (34.3% vs. 6.3%; P=0.0003).

Conclusions

Adding DXZ to CHOP-based therapy in elderly aggressive lymphoma patients leads to higher rates of bone marrow suppression in neutropenia as well as to more frequent events of febrile neutropenia. However, PEG G-CSF prophylaxis was effective in reducing the incidence of neutropenia and febrile neutropenia in patients with DXZ prophylaxis.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.