Effects of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis for chemotherapy-induced febrile neutropenia in diffuse large B-cell lymphoma patients receiving the R-CHOP-21 regimen.

Background: Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) in diffuse large B-cell lymphoma (DLBCL) patients undergoing rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone every 21 d (R-CHOP-21) chemotherapy varies based on physician discretion.

Objectives: The present study aims to investigate the impact of primary G-CSF prophylaxis on febrile neutropenia (FN) and other outcomes in DLBCL patients receiving R-CHOP-21 in real-world practice.

Methods: Medical records of 103 newly diagnosed DLBCL patients, aged 18-80 years, were retrospectively analyzed. Seventy-four patients received primary G-CSF prophylaxis (prophylaxis group), while 29 patients did not receive prophylaxis (non-prophylaxis group). The occurrence of FN and other outcomes was compared between the two groups.

Results: The prophylaxis group had older patients (median ± interquartile ranges [IQR], 63 ± 12 years vs. 50 ± 15 years, P < 0.001). The incidence of FN after the first R-CHOP was not statistically significant between groups (8.3% vs. 17.2%, P = 0.177). However, FN events were significantly higher in non-prophylaxis cycles (7.40%) compared with prophylaxis cycles (2.70%) (P = 0.027). Cumulative FN events were lower in the prophylaxis group (14.9%) than in the non-prophylaxis group (27.6%) (P = 0.134). FN-free survival was not significantly different between prophylaxis and non-prophylaxis groups (hazard ratio [HR], 0.48; 95% confidence interval [95%CI], 0.17-1.35), while primary G-CSF prophylaxis significantly improved event-free survival (HR, 0.36; 95%CI, 0.16-0.84).

Conclusions: Primary G-CSF prophylaxis may reduce the risk of FN in DLBCL patients undergoing R-CHOP-21 treatment. The present study highlights the importance of primary G-CSF prophylaxis, especially for those at high risk of FN.