The Proportion and Associated Factors of Febrile Neutropenia among Non-Hodgkin Lymphoma Patients at Chaiyaphum Hospital

Abstract

Introduction: The CHOP-based chemotherapy regimen plus Rituximab followed by GCSF injection to prevent febrile neutropenia was used in Non-Hodgkin lymphoma patients in Thailand. This study aimed to evaluate the proportion of febrile neutropenia in the Rituximab and GCSF era and investigate potential risk factors for febrile neutropenia.

Methods: A retrospective study was conducted on adult patients diagnosed with Non-Hodgkin lymphoma at Chaiyaphum Hospital. Clinical characteristics of patients and potential risk factors for febrile neutropenia among Non-Hodgkin lymphoma were collected. The proportion of febrile neutropenia was calculated, and possible risk factors were analyzed.

Results: A total of 242 patients were enrolled. The most common subtype of Non-Hodgkin lymphoma was Diffuse large B cell lymphoma (71%). Rituximab was used at 51.2%(124/242), and GCSF was used as primary prophylaxis at 97.1% (235/242). Incidence of febrile neutropenia was 24.79 (60/242). Febrile neutropenia occurred in 24.2% (30/124) vs 25.4% (30/188) among Rituximab use and non-Rituximab use respectively (p-value=0.82). Multivariate analysis showed a significant association between febrile neutropenia in co-morbid disease OR 2.27 (95% CI 1.07-4.84, p-value=0.03) and low serum albumin 2.57 (95% CI 1.24-5.33, p-value=0.01). The main source of infection in neutropenic patients was pneumonia. Septicemia occurred in 15% (9/60) and multiple sources of infection were found in 16.6% (10/60) of all febrile neutropenia patients.

Conclusion: The proportion of febrile neutropenia was not different among the CHOP and R-CHOP groups. GCSF prophylaxis should be used, especially in the presence of comorbid diseases and low serum albumin.

Keywords: Febrile neutropenia, G-CSF prophylaxis, R-CHOP