Neutrrophil toxicity and primary prophylaxis in diffuse large B cell lymphoma treated with R-chop

ABSTRACT

To identify the risk of neutrophil toxicity in patients of advanced stage Diffuse Large B Cell Lymphoma [DLBCL] patients with low to intermediate-risk International prognostic index [IPI] treated with three weekly R-CHOP therapy. Quasi-experimental study. Combined Military Hospital Rawalpindi on 50 patients of advanced stage DLBCL from 1st Jan 2009 to 31st Dec 2009. Patients were observed for occurrence of significant neutrophil toxicity defined as grade 4 neutropenia between day 7 and 10 post therapy, febrile neutropenia and grade 2 or more neutrophil toxicity persisting on day 1 of next cycle. NCI Common Toxicity Criteria version 3.0 was used for grading toxicity. Patients with WHO Performance status scale 4, on immunosuppressive drugs, abnormal hepatic or renal functions and inadequate hematological values were excluded. Fourteen [28%] patients had poor performance status [WHO 2] and amongst them grade 4 neutrophil toxicity was seen in 8[57%] and 3 got complicated with febrile neutropenia. In the remaining 36 [72%] patients with good performance status [WHO 0 or 1] only 2[5.5%] developed grade 4 toxicity none getting complicated with febrile neutropenia. Frequency of neutrophil toxicity was 20% in Non Hodgkin's Diffuse Large B Cell Lymphomas [Low and Intermediate IPI] patients treated with 3 weekly R-CHOP. Patients with WHO performance status scale 2 are high-risk for developing significant neutrophil toxicity and therefore require primary neutropenia prophylaxis