Factors Associated with Chemotherapy-Induced Neutropenia in Diffuse Large B-Cell Lymphoma Patients Undergoing Combination Chemotherapy: A Case-Control Study
Keywords:
Diffuse large B-cell lymphoma, Chemotherapy-induced febrile neutropenia, Precipitating factorsAbstract
Purpose: This study aimed to identify the factors associated with chemotherapy-induced neutropenia (CIN) in diffuse large B-cell lymphoma (DLBCL) patients undergoing combination chemotherapy. Methods: A total of 111 patients with DLBCL participated in this study at C University Hospital. The CIN group consisted of patients with an absolute neutrophil count (ANC) lower than 1,000 cells/μL. Clinical factors, the level of depression, and the level of healthy lifestyle were measured on the chemotherapy administration day, and the ANC was measured on the next follow-up day. Results: Binary logistic regression analysis showed that the factors associated with CIN in DLBCL were the presence of B symptoms at diagnosis (β = 4.69) and low-risk CIN regimen (β = 0.10) among clinical factors, and the level of healthy lifestyle (β = 0.17). Conclusion: Oncology nurses should focus on the patients vulnerable to CIN having B symptoms at diagnosis, receiving a low-risk CIN regimen, and showing non-adherence to healthy lifestyle practice. Administration of granulocyte colony-stimulating factor can be considered for the patients receiving low-risk CIN regimen to reduce CIN. Education programs including healthy lifestyle practice for improving the immune system should be applied to DLBCL patients.
References
Bray F, Ferlay J, Soerjomataram I, et al., 2018, Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2018(68): 394–424.
van Leeuwen MT, Turner JJ, Joske DJ, et al., 2014, Lymphoid Neoplasm Incidence by WHO Subtype in Australia 1982–2006. Int J Cancer, 2014(135): 2146–2156.
Pfreundschuh M, Kuhnt E, Trümper L, et al., 2011, CHOP-Like Chemotherapy with or Without Rituximab in Young Patients with Good-Prognosis Diffuse Large-B-Cell Lymphoma: 6-Year Results of an Open-Label Randomised Study of the MabThera International Trial (MInT) Group. Lancet Oncol, 2011(12): 1013–1022.
Aapro MS, Bohlius J, Cameron DA, et al., 2011, 2010 Update of EORTC Guidelines for the Use of Granulocyte Colony-Stimulating Factor to Reduce the Incidence of Chemotherapy-Induced Febrile Neutropenia in Adult Patients with Lymphoproliferative Disorders and Solid Tumours. Eur J Cancer, 2011(47): 8–32.
Boccia R, Glaspy J, Crawford J, et al., 2022, Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden that Needs to be Tamed? Oncologist, 2022(27): 625–636.
Lalami Y, Klastersky J, 2017, Impact of Chemotherapy-Induced Neutropenia (CIN) and Febrile Neutropenia (FN) on Cancer Treatment Outcomes: An Overview About Well-Established and Recently Emerging Clinical Data. Crit Rev Oncol Hematol, 2017(120): 163–179.
Choi YW, Jeong SH, Ahn MS, et al., 2014, Patterns of Neutropenia and Risk Factors for Febrile Neutropenia of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP. J Korean Med Sci, 2014(29): 1493–1500.
Usami E, Kimura M, Iwai M, et al., 2016, Chemotherapy Continuity and Incidence of Febrile Neutropenia with CHOP Therapy in an Outpatient Setting. Mol Clin Oncol, 2016(4): 591–596.
Lyman GH, Abella E, Pettengell R, 2014, Risk Factors for Febrile Neutropenia Among Patients with Cancer Receiving Chemotherapy: A Systematic Review. Crit Rev Oncol Hematol, 2014(90): 190–199.
Bartlett DB, Fox O, McNulty CL, et al., 2016, Habitual Physical Activity is Associated with the Maintenance of Neutrophil Migratory Dynamics in Healthy Older Adults. Brain Behav Immun, 2016(56): 12–20.
Tavakoli-Ardakani M, Beyraghi N, Mirjalili M, et al., 2019, Effect of Pretransplant Depression on Neutrophil Recovery Following Hematopoietic Stem Cell Transplantation. Transpl Res Risk Manag, 2019(11): 1–9.
Howard R, Scheiner A, Kanetsky PA, et al., 2019, Sociodemographic and Lifestyle Factors Associated with the Neutrophil-To-Lymphocyte Ratio. Ann Epidemiol, 2019(38): 11–21.
American Society of Clinical Oncology, n.d., Coping with Cancer, viewed September 11, 2022, https://www.cancer.net/coping-with-cancer/physicalemotional-and-social-effects-cancer/managing-physical-side-effects/neutropenia
Freites-Martinez A, Santana N, Arias-Santiago S, et al., 2021, Using the Common Terminology Criteria for Adverse Events (CTCAE – Version 5.0) to Evaluate the Severity of Adverse Events of Anticancer Therapies. Actas Dermosifiliogr (Engl Ed), 2021(112): 90–92.
Hassan BA, Yusoff ZB, Othman SB, 2015, A Close Look at Neutropenia Among Cancer Patients: Risk Factor and Management, in Updates on Cancer Treatment, IntechOpen, London, 1–23.
Oken MM, Creech RH, Tormey DC, et al., 1982, Toxicity and Response Criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol, 1982(5): 649–655.
Lee M, Yee J, Kim JY, et al., 2019, Risk Factors for Neutropenia and Febrile Neutropenia Following Prophylactic Pegfilgrastim. Asia Pac J Clin Oncol, 2019(15): 231–237.
Quan H, Li B, Couris CM, et al., 2011, Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data from 6 Countries. Am J Epidemiol, 2011(173): 676–682.
Carbone PP, Kaplan HS, Musshoff K, et al., 1971, Report of the Committee on Hodgkin’s Disease Staging Classification. Cancer Res, 1971(31): 1860–1861.
Becker PS, Griffiths EA, Alwan LM, et al., 2020, NCCN Guidelines Insights: Hematopoietic Growth Factors, Version 1.2020. J Natl Compr Canc Netw, 2020(18): 12–22.
Lyman GH, Kuderer NM, Crawford J, et al., 2011, Predicting Individual Risk of Neutropenic Complications in Patients Receiving Cancer Chemotherapy. Cancer, 2011(117): 1917–1927.
Walker SN, Sechrist KR, Pender NJ, 1987, The Health-Promoting Lifestyle Profile: Development and Psychometric Characteristics. Nurs Res, 1987(36): 76–81.
Seo HM, 2001, Construction of Health Promoting Behaviors Model in Elderly, thesis, Seoul National Univ., Seoul.
Sung HM, Kim JB, Park YN, et al., 2008, Study on the Reliability and the Validity of Korean Version of the Beck Depression Inventory-II (BDI-II). J Korean Soc Biol Ther Psychiatry, 2008(14): 201–212.
Moghaddam SR, Elmieh A, Chafy MR, 2021, The Effect of Leisure Time Regular Exercise on Neutrophil Function, Myeloperoxidase Levels, and Antioxidant Capacity in Middle-Aged Men. Med Sci J Islamic Azad Uni, 2021(31): 413–424.
Arends J, Bachmann P, Baracos V, et al., 2017, ESPEN Guidelines on Nutrition in Cancer Patients. Clin Nutr, 2017(36): 11–48.
O’Malley M, Healy P, Daignault S, et al., 2013, Cigarette Smoking and Gemcitabine-Induced Neutropenia in Advanced Solid Tumors. Oncology, 2013(85): 216–222.
Vusqa U, Jayakrishnan TT, Bakalov V, et al., 2022, Predictors and Long-Term Outcomes for Diffuse Large B-Cell Lymphoma (DLBCL) Patients Undergoing Surgery Prior to Systemic Therapy: A Nationwide Analysis. Cureus, 2022(14): e24448.
Sharma R, Cunningham D, Smith P, et al., 2009, Inflammatory (B) Symptoms are Independent Predictors of Myelosuppression from Chemotherapy in Non-Hodgkin Lymphoma (NHL) Patients--Analysis of Data from a British National Lymphoma Investigation Phase III Trial Comparing CHOP to PMitCEBO. BMC Cancer, 2009(9): 153.
Makihara K, Shimeda Y, Matsumura T, 2021, Influence of Concomitant Polypharmacy on Docetaxel-Induced Febrile Neutropenia. Cancer Diagn Progn, 2021(1): 135–141.
