Table 3.
Incidence of grade 1–4 neutropenia
| Study | Neutropenia | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Balducci [19] | Neutropenia | Combined CHOP and R-CHOP Q2W | Combined CHOP and R-CHOP Q3W | ||||||
| < 65 years | 65–75 years | > 75 years | Overall | < 65 years | 65–75 years | > 75 years | Overall | ||
| Any grade, n (%) | 0 (0) | 1 (3.3) | – | 1 (1.6) | 0 (0) | 5 (6.4) | 1 (3.1) | 6 (4.4) | |
| Grade ≥ 3, n (%) | 0 (0) | 0 (0) | – | 0 (0) | 0 (0) | 2 (2.6) | 1 (3.1) | 3 (2.2) | |
| Donkor [21] | Pegfilgrastim < 14 days group (n = 126) | Pegfilgrastim > 14 days group (n = 25) | Filgrastim group (n = 90) | No CSF group (n = 295) | |||||
| Incidence of neutropenia, n (%) | 0 (0) | 1 (4) | 24 (26.7) | 25 (8.5) | |||||
| Dragnev [22] | Filgrastim (n = 25) | Pegfilgrastim (n = 10) | p value | ||||||
| WBC/ANC (any grade toxicity) | 2 | 0 | p = 1.0 | ||||||
| Hecht [23] | Placebo (n = 118) | Pegfilgrastim (n = 123) | OR (95% CI) | p value | |||||
| All combined, % (95% CI) | 43 (34.3–52.1) | 13 (7.2–18.9) | 0.19 (0.10–0.37) | p < 0.001 | |||||
| FOLFOX-4, % (95% CI) | n = 58 | n = 61 | 0.11 (0.04–0.36) | p < 0.001 | |||||
| 37.9 (25.5–51.6) | 6.6 (1.8–15.9) | ||||||||
| FOLFIRI, % (95% CI) |
n = 30 50.0 (31.3–68.7) |
n = 32 15.6 (5.3–32.8) |
0.19 (0.06–0.61) | p = 0.0061 | |||||
| FOIL, % (95% CI) |
n = 30 46.7 (28.3–65.7) |
n = 30 23.3 (9.9–42.3) |
0.35 (0.11–1.05) | p < 0.1033 | |||||
| Kourlaba [25] | Severe neutropenia, % (95% CI) | Filgrastim | Pegfilgrastim | p value | |||||
| 32.3 (28.4–36.5) | 10.4 (7.9–13.3) | p < 0.001 | |||||||
| Kurbacher [26] | Grade 3/4 neutropenia, % | Pegfilgrastim (n = 27) | Lipegfilgrastim (n = 26) | ||||||
| 5.6 | 3.5 | ||||||||
| Lane [27] | Duration of grade 4 neutropenia | Pegfilgrastim | G-CSF | p value | |||||
| All cycles, days (95% CI) | 4 (0–11) | 4 (0–10) | 0.55 | ||||||
| A cycles, days (95% CI) | 2 (0–7) | 2 (0–6) | 0.65 | ||||||
| B cycles, days (95% CI) | 6 (2–12) | 6 (0–10) | 0.70 | ||||||
| Pinter [30] | Neutropenia grade | Pegfilgrastim, n (%) | Placebo, n (%) | Difference | OR (95% CI) | p value | |||
| Grade 3/4 | 15 (3.6) | 72 (17) | −13.5% (−18.3, −8.7) | 0.18 (0.1–0.32) | < 0.001 | ||||
| Grade 4 | 10 (2.4) | 35 (8.3) | −5.9% (−9.6, −2.2) | 0.27 (0.13–0.56) | < 0.001 | ||||
| Grade 3/4 in FOLFOX-treated patients | 4 (1.9) | 37 (17.9) | n/a | 0.09 (0.03–0.26) | n/a | ||||
| Grade 3/4 in FOLFIRI-treated patients | 11 (5.1) | 35 (16.2) | n/a | 0.28 (0.14–0.57) | n/a | ||||
| Grade 3/4 in low-dose patients | 4 (2.5) | 28 (16.1) | n/a | 0.13 (0.05–0.39) | n/a | ||||
| Grade 3/4 in high-dose patients | 11 (4.2) | 44 (17.7) | n/a | 0.20 (0.10–0.41) | n/a | ||||
| Skarlos [31] | Filgrastim | Pegfilgrastim | p value | ||||||
| Severe neutropenia, n (%) | 34 (32) | 41 (38) | p = 0.36 | ||||||
ANC absolute neutrophil count, CHOP cyclophosphamide, doxorubicin, vincristine, and prednisone, CI confidence interval, CSF colony-stimulating factor, FOIL 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan, FOLFIRI 5-fluorouracil, leucovorin, and irinotecan, FOLFOX 5-fluorouracil, leucovorin, and oxaliplatin, G-CSF granulocyte colony-stimulating factor, n/a not applicable, OR odds ratio, Q2W biweekly, Q3W every 3 weeks, R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, WBC white blood cell