Community-Based Trial of R-CHOP and Maintenance Rituximab for Intermediate- or High-Grade Non-Hodgkin Lymphoma with First-Cycle Filgrastim for Older Patients

Abstract Background: Administration of full-dose R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) chemotherapy is important to maximize response in patients with intermediate-or high-grade non-Hodgkin lymphoma but might be difficult in older patients. Patients and Methods: This community-based study was conducted to determine response, toxicity, and disease-free survival in patients with intermediate-or high-grade non-Hodgkin lymphoma receiving R-CHOP with filgrastim. Patients received 6-8 cycles of R-CHOP followed by 4 cycles of maintenance rituximab for responders. Patients aged > 60 years or with increased infection risk received filgrastim 5 μg/kg per day in all R-CHOP cycles; other patients received filgrastim after a neutropenic event (no planned administration for cycle 1). Results: Of 101 patients enrolled, 60 (59%) were aged > 60 years and received filgrastim in all cycles. Thirty-three patients aged ≤ 60 years (80%) received filgrastim, 7 (17%) as primary use in cycle 1. Chemotherapy average relative dose intensity was comparable between age groups (91% > 60 years vs. 93% ≤ 60 years). Overall response was similar in both groups (87% > 60 years vs. 95% ≤ 60 years; P = 0.19); however, the complete response rate was significantly lower for older patients (42% > 60 years vs. 71% ≤ 60 years; P = 0.005). Seventy-six percent of patients (75% > 60 years vs. 78% ≤ 60 years) had no evidence of progression after 2 years of follow-up. Febrile neutropenia (fever ≥ 38.3°C with absolute neutrophil count 60 years vs. 10% ≤ 60 years), and 8% had cycle-1 events (12% > 60 years vs. 2% ≤ 60 years). Conclusion: Patients aged > 60 years receiving R-CHOP with filgrastim support in all cycles received comparable doses of chemotherapy and had similar overall response rates compared wtih those of younger patients receiving no preemptive cycle-1 filgrastim.