Originally published as JCO Early Release 10.1200/JCO.2004.03.213 on September 20 2004

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lyman, G. H. Articles by Fisher, R. I. Search for Related Content PubMed PubMed Citation Articles by Lyman, G. H. Articles by Fisher, R. I. Social Bookmarking                            What's this?

Incidence and Predictors of Low Chemotherapy Dose-Intensity in Aggressive Non-Hodgkin's Lymphoma: A Nationwide Study

From the University of Rochester, Rochester, NY; University of Washington, Seattle, WA; and Duke University, Durham, NC

Address reprint requests to Gary H. Lyman, MD, MPH, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642; e-mail: Gary_Lyman{at}urmc.rochester.edu

PURPOSE: To assess the incidence of and risk factors for reduced relative dose-intensity (RDI) in patients treated with chemotherapy for aggressive non-Hodgkin's lymphoma (NHL).

METHODS: A nationwide survey was conducted of 567 oncology practices with data extracted from the records of 4,522 patients with aggressive NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP); CHOP-rituximab (CHOP-R); or cyclophosphamide, mitoxantrone, vincristine, and prednisone (CNOP). The primary outcome was the average RDI for each regimen based on both planned and reference standards. Other assessments included the incidence of febrile neutropenia and patterns of colony-stimulating factor (CSF) use, as well as the average RDI in high-risk subgroups.

RESULTS: Dose reductions 15% occurred in 40% of patients and treatment delays 7 days occurred in 24% of patients, resulting in 53% and 48% of patients receiving an RDI less than 85% of the minimum six-cycle and National Comprehensive Cancer Network guideline standards, respectively. Reduced RDI was more prevalent in older patients, with 60% of patients older than 60 years receiving RDI less than 85%. Multivariate analysis identified several independent predictors for reduced RDI, including age older than 60 years, advanced disease stage, poor performance status, and no prophylactic CSF use. Age was no longer a significant risk factor in patients who received prophylactic CSF.

CONCLUSION: Patients with aggressive and potentially curable NHL treated with CHOP, CHOP-R, or CNOP frequently receive reduced RDI. Predictive models based on the risk factors identified for reduced RDI should enable the targeted use of appropriate supportive care, facilitating the delivery of full chemotherapy doses on schedule.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. Crawford, J. Armitage, L. Balducci, C. Bennett, D. W. Blayney, S. R. Cataland, D. C. Dale, G. D. Demetri, H. P. Erba, J. Foran, et al. Myeloid Growth Factors J Natl Compr Canc Netw, January 1, 2009; 7(1): 64 - 83. [Abstract] [PDF]

				G. H. Lyman Impact of Chemotherapy Dose Intensity on Cancer Patient Outcomes J Natl Compr Canc Netw, January 1, 2009; 7(1): 99 - 108. [Abstract] [PDF]

				D. L. Hershman, R. B. McBride, A. Eisenberger, W. Y. Tsai, V. R. Grann, and J. S. Jacobson Doxorubicin, Cardiac Risk Factors, and Cardiac Toxicity in Elderly Patients With Diffuse B-Cell Non-Hodgkin's Lymphoma J. Clin. Oncol., July 1, 2008; 26(19): 3159 - 3165. [Abstract] [Full Text] [PDF]

				G. H. Lyman Undertreatment of Cancer Patients With Chemotherapy Is a Global Concern J. Oncol. Pract, May 1, 2008; 4(3): 114 - 115. [Full Text] [PDF]

				C. Thieblemont, A. Grossoeuvre, R. Houot, F. Broussais-Guillaumont, G. Salles, C. Traulle, D. Espinouse, and B. Coiffier Non-Hodgkin's lymphoma in very elderly patients over 80 years. A descriptive analysis of clinical presentation and outcome Ann. Onc., April 1, 2008; 19(4): 774 - 779. [Abstract] [Full Text] [PDF]

				J. Crawford, D. C. Dale, N. M. Kuderer, E. Culakova, M. S. Poniewierski, D. Wolff, and G. H. Lyman Risk and Timing of Neutropenic Events in Adult Cancer Patients Receiving Chemotherapy: The Results of a Prospective Nationwide Study of Oncology Practice J Natl Compr Canc Netw, February 1, 2008; 6(2): 109 - 118. [Abstract] [PDF]

				L. Balducci, H. Al-Halawani, V. Charu, J. Tam, S. Shahin, L. Dreiling, and W. B. Ershler Elderly Cancer Patients Receiving Chemotherapy Benefit from First-Cycle Pegfilgrastim Oncologist, December 1, 2007; 12(12): 1416 - 1424. [Abstract] [Full Text] [PDF]

				Y. Terada, H. Nakamae, T. Nakane, H. Koh, Y. Takeoka, R. Moriguchi, M. Aimoto, Y. Akazawa, E. Wada, H. Kanashima, et al. The Impact of Relative Dose Intensity (RDI) of CHOP on Outcome of Diffuse Large B-Cell Lymphoma: Results of a Single Center Study. Blood (ASH Annual Meeting Abstracts), November 16, 2007; 110(11): 4456 - 4456. [Abstract]

				N. M. Kuderer, D. C. Dale, J. Crawford, and G. H. Lyman Impact of Primary Prophylaxis With Granulocyte Colony-Stimulating Factor on Febrile Neutropenia and Mortality in Adult Cancer Patients Receiving Chemotherapy: A Systematic Review J. Clin. Oncol., July 20, 2007; 25(21): 3158 - 3167. [Abstract] [Full Text] [PDF]

				S. M. Lichtman, H. Wildiers, E. Chatelut, C. Steer, D. Budman, V. A. Morrison, B. Tranchand, I. Shapira, and M. Aapro International Society of Geriatric Oncology Chemotherapy Taskforce: Evaluation of Chemotherapy in Older Patients--An Analysis of the Medical Literature J. Clin. Oncol., May 10, 2007; 25(14): 1832 - 1843. [Abstract] [Full Text] [PDF]

				C. Thieblemont and B. Coiffier Lymphoma in Older Patients J. Clin. Oncol., May 10, 2007; 25(14): 1916 - 1923. [Abstract] [Full Text] [PDF]

				H. Ozer, B. Mirtsching, M. Rader, S. Luedke, S. J. Noga, B. Ding, and L. Dreiling Neutropenic Events in Community Practices Reduced by First and Subsequent Cycle Pegfilgrastim Use Oncologist, April 1, 2007; 12(4): 484 - 494. [Abstract] [Full Text] [PDF]

				C. Kloft, J. Wallin, A. Henningsson, E. Chatelut, and M. O. Karlsson Population Pharmacokinetic-Pharmacodynamic Model for Neutropenia with Patient Subgroup Identification: Comparison across Anticancer Drugs. Clin. Cancer Res., September 15, 2006; 12(18): 5481 - 5490. [Abstract] [Full Text] [PDF]

				R. E. Smith Jr. Trends in Recommendations for Myelosuppressive Chemotherapy for the Treatment of Solid Tumors J Natl Compr Canc Netw, August 1, 2006; 4(7): 649 - 658. [Abstract] [PDF]

				A. I. Neugut, M. Matasar, X. Wang, R. McBride, J. S. Jacobson, W.-Y. Tsai, V. R. Grann, and D. L. Hershman Duration of Adjuvant Chemotherapy for Colon Cancer and Survival Among the Elderly J. Clin. Oncol., May 20, 2006; 24(15): 2368 - 2375. [Abstract] [Full Text] [PDF]

				X. L. Du, D. R. Lairson, C. E. Begley, and S. Fang Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort J. Clin. Oncol., December 1, 2005; 23(34): 8620 - 8628. [Abstract] [Full Text] [PDF]

				S. A. Gregory and L. Trumper Chemotherapy dose intensity in non-Hodgkin's lymphoma: is dose intensity an emerging paradigm for better outcomes? Ann. Onc., September 1, 2005; 16(9): 1413 - 1424. [Abstract] [Full Text] [PDF]

				G. H. Lyman Guidelines of the National Comprehensive Cancer Network on the Use of Myeloid Growth Factors with Cancer Chemotherapy: A Review of the Evidence J Natl Compr Canc Netw, July 1, 2005; 3(4): 557 - 571. [Abstract] [PDF]

				G. H. Lyman, C. H. Lyman, O. Agboola, and for the Anc Study Group Risk Models for Predicting Chemotherapy-Induced Neutropenia Oncologist, June 1, 2005; 10(6): 427 - 437. [Abstract] [Full Text] [PDF]