SEVERITY OF NEUTROPENIA IN PATIENTS WITH NON-HODGKIN B-CELL LYMPHOMAS ON R-CHOP CHEMOTHERAPY REGIMEN
Main Article Content
Keywords
Non-Hodgkin's lymphomas, Chemotherapy, Neutropenia
Abstract
Background: Neutropenia is a condition in which the neutrophil concentration in the blood is unusually low. A reduction in the non-marginal pool's circulating neutrophils is known as neutrtropenia. Drug-induced neutropenia affects one person in a million per year, according to the CDC. Non- Hodgkin's lymphoma (NHL) is the category of lymphoproliferative diseases with various clinical and histological presentations.
Objective: To assess the frequency of neutropenia and its severity in patients diagnosed with B-cell Non-Hodgkin's lymphomas on R-CHOP chemotherapy regimen
Material & Methods
Study Design: Cross - sectional study
Study place: Department of Oncology, Combined Military Hospital, Rawalpindi
Duration: 06 months i.e. from 20-5-2019 to 20-11-2019
Data collection: After meeting the inclusion criteria 90 patients were enrolled in this study. Then patients were planned for the first session of RCHOP chemotherapy. The dose of chemotherapy was estimated by using body surface area as per standard guidelines given in operational definition. 48 hours after completion of first cycle of RCHOP therapy, blood CP was performed from the hospital laboratory and neutrophil count along with hemoglobin level was observed. Grade of neutropenia was assessed as per operational definitions.
Results: The mean age of patients was 43.43±11.73 years, 53 (58.89%) were male. Zero grade of anemia was noted in 38 (42.2%) patients. Out of 90 patients, neutropenia was noted in 45 (50%) patients.
Conclusion: Approximately half of the total patients developed neutropenia who were diagnosed with B-cell NHL on R-CHOP chemotherapy regimen
References
2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians 2015;65(2):87-108.
3. Bukhari U, Jamal S, Lateef F. NON HODGKIN'S LYMPHOMA" A STUDY. Pakistan Oral and Dental Journal 2015;35(3).
4. Tariq A, Aziz MT, Mehmood Y, Asghar SA, Khurshid A. Clinical Response to CHOP vs. R-CHOP in Adult Patients with Diffuse Large B-Cell Lymphomas. Asian Pacific journal of cancer prevention: APJCP 2018;19(5):1181.
5. Tariq A, Khurshid A, Mehmood Y. Potential Risk Factors and Prevalence Trend of Diffuse Large Beta Cell Lymphoma in Pakistani population. International Journal of Pharmaceutical Research & Allied Sciences 2015;4(3).
6. Li S, Young KH, Medeiros LJ. Diffuse large B-cell lymphoma. Pathology 2018;50(1):74-87.
7. Martelli M, Ferreri AJ, Agostinelli C, Di Rocco A, Pfreundschuh M, Pileri SA. Diffuse large B-cell lymphoma. Critical reviews in oncology/hematology 2013;87(2):146-71.
8. Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, et al. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology 2015;26(suppl_5):v116-v25.
9. Qubtia M, Munawar K, Hamid MA, Badar F, Siddiqui N, Kazmi SA, et al. CHARACTERISTICS AND OUTCOME OF PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA-TREATED WITH CHEMOTHERAPY OR CHEMO-IMMUNOTHERAPY. Journal of Ayub Medical College Abbottabad 2016;28(2):254-8.
10. Salles G, Barrett M, Foà R, Maurer J, O’Brien S, Valente N, et al. Rituximab in B-cell hematologic malignancies: a review of 20 years of clinical experience. Advances in therapy 2017;34(10):2232-73.
11. Rojnuckarin P. High Incidence of Febrile Neutropenia in Non-Hodgkin Lymphoma Patients Receiving CHOP Chemotherapy despite G-CSF Prophylaxis. Journal of Hematology and Transfusion Medicine 2017;27(1):45-56.
12. Lalami Y, Klastersky J. Impact of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) on cancer treatment outcomes: an overview about well-established and recently emerging clinical data. Critical reviews in oncology/hematology 2017;120:163-79.
13. Dinan MA, Hirsch BR, Lyman GH. Management of chemotherapy-induced neutropenia: measuring quality, cost, and value. Journal of the National Comprehensive Cancer Network 2015;13(1):e1-e7.
14. Choi YW, Jeong SH, Ahn MS, Lee HW, Kang SY, Choi J-H, et al. Patterns of neutropenia and risk factors for febrile neutropenia of diffuse large B-cell lymphoma patients treated with rituximab-CHOP. Journal of Korean Medical Science 2014;29(11):1493-500.
15. Yokoyama M, Kusano Y, Takahashi A, Inoue N, Ueda K, Nishimura N, et al. Incidence and risk factors of febrile neutropenia in patients with non-Hodgkin B-cell lymphoma receiving R-CHOP in a single center in Japan. Supportive Care in Cancer 2017;25(11):3313-20.
16. Herold M, Hieke K. Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine. The European Journal of Health Economics 2002;3(3):166-72.
17. Nadeem M, Idrees M, Khattak J, Hussain I, Amin Z, Arif S, et al. frequency and severity of neutropenia in diffuse large B-cell non hodgkin’s lymphoma after first cycle of Chemotherapy comprising cyclophosphamide, Doxorubicin, vincristine with prednisolon. Journal of Ayub Medical College Abbottabad 2011;23(1):80-3.
18. Andersen C, Tesfa D, Siersma VD, Sandholdt H, Hasselbalch H, Bjerrum O, et al. Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study. Journal of internal medicine 2016;279(6):566-75.
19. Christopher D Braden. Neutropenia. 2018 [cited 2020]; Available from: https://emedicine.medscape.com/article/204821-overview.
20. Intragumtornchai T, Sutheesophon J, Sutcharitchan P, Swasdikul D. A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin's lymphoma. Leukemia & lymphoma 2000;37(3-4):351-60.
21. Rabinowitz A, Weiner N, Steinberg D, Sparks J, Fridman M, Liberman R, et al. Severe neutropenia in cycle one of CHOP is a marker of early death among intermediate and high grade lymphoma (IHL) patients. Journal of Clinical Oncology 2004;22(14_suppl):6717-.
22. Rabinowitz AP, Weiner NJ, Tronic BS, Fridman M, Liberman RF, Delgado DJ. Severe neutropenia in CHOP occurs most frequently in cycle 1: a predictive model. Leukemia & lymphoma 2006;47(5):853-8.
23. Wang H, Naghavi M, Allen C, Barber R, Bhutta Z, Carter A, et al. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1459-544.
24. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet 2016;388(10053):1459-544.
25. seer.cancer. Cancer Stat Facts: Non-Hodgkin Lymphoma. 2020; Available from: https://seer.cancer.gov/statfacts/html/nhl.html.
26. lymphoma, Auperin A, Michon J, Behrendt H, Leverger G, Frappaz D, et al. Non-Hodgkin Lymphoma Overview. 2020 [cited 2020]; Available from: https://www.lymphoma.org.au/page/9/non-hodgkin-lymphoma.
27. Ellison LF, De P, Mery LS, Grundy PE. Canadian cancer statistics at a glance: cancer in children. Cmaj 2009;180(4):422-4.
28. cancerresearchuk. Non-Hodgkin lymphoma statistics. 2020 [cited 2020]; Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-hodgkin-lymphoma.
29. seer.cancer. Cancer Stat Facts: Non-Hodgkin Lymphoma. 2020 [cited 2020]; Available from: https://seer.cancer.gov/statfacts/html/nhl.html.
30. M.H. Mengal, Z. Mehmood, C. Kapoor, M. Iqbal. Frequency of chemotherapy induced neutropenia in patients of non Hodgkin's lymphoma. 2014.
31. Morrison VA, Picozzi V, Scott S, Pohlman B, Dickman E, Lee M, et al. The impact of age on delivered dose intensity and hospitalizations for febrile neutropenia in patients with intermediate-grade non-Hodgkin's lymphoma receiving initial CHOP chemotherapy: a risk factor analysis. Clinical lymphoma 2001;2(1):47-56.
32. Nitta E, Izutsu K, Sato T, Ota Y, Takeuchi K, Kamijo A, et al. A high incidence of late-onset neutropenia following rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphoma: a single-institution study. Annals of oncology 2007;18(2):364-9.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Assam Ahmad
Registrar medical oncology unit Allied hospital Abbottabad
Bilal Ahmad
Senior Registrar Oncology Kuwait teaching hospital Peshawar
Syeda Sama Bilal
Medical Officer Health Department KPK
Jahan Sardar
AP medicine Kuwait teaching hospital Peshawar
Sohail Ahmad
Specialist Registrar Oncology Hayatabad medical complex Peshawar
Rahimullah Khattak
AP Medical Oncology Hayatabad Medical Complex Peshawar