Febrile neutropenia (FN) and chemotherapy-induced neutropenia (CIN) are common conditions involving dose reduction or delayed chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL). Owing to the lack of real-word data on the effectiveness of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-based primary prophylaxis (PP) in literature, we aimed to investigate the effects of PP with R-CHOP on the incidence of FN/CIN-related hospitalizations, overall survival (OS), and length of hospital stay in DLBCL patients.
A population-based cohort study of 11,491 DLBCL patients who underwent R-CHOP during 2010-2016 was conducted using data from the National Health Insurance Service.
PP was introduced to South Korea in 2014. R-CHOP-based PP reduced infection-related hospitalizations by 16% compared with the same treatment before reimbursement (hazard ratio [HR]=0.84, P<0.001). By year, infection-related hospitalizations in patients who received PP from 2014 to 2016 significantly decreased in terms of the HR to 0.79, 0.87, and 0.78, respectively, compared with those in patients who received PP in 2013 (P<0.001; P=0.002; and P<0.001). Length of hospital stays decreased by 4.4, 4.0, and 2.3 days from 2014 to 2016 compared with that in 2013 in patients receiving PP (P=0.024, P=0.009, and P=0.076). However, PP did not show any significant difference in 5-year OS rates (HR=0.97, P=0.474).
The introduction of PP with R-CHOP in DLBCL did not provide any significant benefit in OS; however, it lowered the risk of infection-related hospitalization and shortened the length of hospital stay. This is the first study to use real-world data from the National Health Insurance Service on PP for DLBCL patients with FN/CIN.
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All authors have declared no conflicts of interest.