Low incidence of neutropenic events in patients with lymphoma receiving first-cycle pegfilgrastim with chemodierapy: Results from a prospective community-based study

Background: Most alterations to chemotherapy dose and schedule are because of neutropenic events, which mainly occur in the first chemotherapy cycle. This prospective, community-based study evaluated the effectiveness of pegfilgrastim in patients with lymphoma who were also receiving chemotherapy. Patients and Methods: Patients aged >= 18 years with cancer other than leukemia or myelodysplastic syndromes were eligible, including patients with major comorbidities who were generally not eligible for most clinical trials. Key exclusions were weekly chemotherapy and concurrent radiation therapy. Patients received pegfilgrastim 6 mg approximately 24 hours after chemotherapy in each cycle (up to 8 cycles). Endpoints included neutropenic complications and serious adverse events. Results: This open-label single-arm study enrolled 2249 patients at 319 sites. Of these 2249 patients, 325 patients with non-Hodgkin lymphoma (NHL) and 46 patients with Hodgkin disease were included in the primary analysis set. The median age was 65 years for patients with NHL and 41 years for patients with Hodgkin disease, and 31% and 26% had major comorbidities, respectively. Few patients experienced neutropenic complications, including grade 4 febrile neutropenia (patients with Hodgkin disease: 0 [95% confidence interval (Cl), 0-8%]; patients with NHL 13% [95% Cl, 10%-17%]); febrile neutropenia-related hospitalization (patients with Hodgkin disease: 0 [95% Cl, 0-8%]; patients with NHL 10% [95% Cl, 7%-14%]), neutropenia-related dose reduction (patients with Hodgkin disease: 0 [95% Cl, 0-8%]; patients with NHL 5% [95% Cl, 3%-8%]), and neutropenia-related dose delay (patients with Hodgkin disease: 0 [95% Cl, 0-8%]; patients with NHL 5% [95% Cl, 3%-8%]). Serious adverse events were consistent with those observed in patients receiving myelosuppressive chemotherapy. Conclusion: Patients with lymphoma receiving myelosuppressive chemotherapy supported by pegfilgrastim experienced few neutropenic complications or neutropenia-related alterations in chemotherapy dose and schedule.