Over the Past 2 Decades, Use of G-CSF in Non-Hodgkin Lymphoma Increased Significantly

February 1, 2019

Among older patients with non-Hodgkin lymphoma receiving myelosuppressive chemotherapy, use of primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) increased significantly over the past 20 years.

While there is an abundance of research validating the efficacy of primary prophylaxis with granulocyte colony-stimulating factors (G-CSF) for reducing the risk of febrile neutropenia, few studies have looked at trends of treatment uptake over time. Looking at patients with non-Hodgkin lymphoma over a 20-year period, researchers determined that there was a significant increase in primary prophylaxis with G-CSF among older patients with non-Hodgkin lymphoma, which translated into fewer febrile neutropenia hospitalizations in the first cycle of chemotherapy.

The findings, presented at the 60th American Society of Hematology Annual Meeting & Exposition, demonstrated that from 1995 to 2015, the use of primary prophylaxis with G-CSF increased significantly among older patients diagnosed with non-Hodgkin lymphoma receiving myelosuppressive chemotherapy starting in 2002.

Drawing on Medicare data, the researchers identified 528 to 717 patients yearly between 1995 and 2007 and 1877 to 2640 patients yearly between 2008 and 2015. Patients were enrolled in Medicare Part A or Part B for 12 months before chemotherapy initiation. The first cycle began at initiation of chemotherapy and ended at the next administration at least 6 days but no more than 35 days after initiation.

Over the 20-year period, the amount of patients aged 80 or older increased from 39% in 1995 to 44% in 2015. Before 1997, the proportion of patients receiving high or intermediate febrile neutropenia risk regimens was less than 20%. This proportion increased to 36% in 1997 and to between 40% and 46% between 1998 and 2015. Most patients receiving high or intermediate febrile neutropenia risk regimens (88% to 96%) were receiving CHOP-21 (cyclophosphamide, doxorubicin, and vincristine every 21 days with or without rituximab).

During that same period, use of G-CSF for primary prophylaxis increased from 8% in 1995 to 60% in 2015. According to the researchers, this increase was largely due to the introduction of pegfilgrastim in 2002. As expected, G-CSF use was more common among patients receiving high or intermediate febrile neutropenia risk regimens compared with patients receiving regimens of other risk.

Meanwhile, the prevalence of neutropenia-related hospitalization in the first cycle of chemotherapy decreased by an average of 6% each year until 2010 when rates became stagnant.

“Further studies are needed to understand overall decreasing trends in neutropenia-related hospitalization and effects of changes in chemotherapy and febrile neutropenia management,” noted the researchers.

Reference

Li S, Liu J, Guo H, et al. Trends in neutropenia-related hospitalization in older patients with non-Hodgkin lymphoma (NHL) receiving myelosuppressive chemotherapy in the United States: 1995-2015. Presented at: 60th American Society of Hematology Annual Meeting & Exposition; December 1, 2018; San Diego, CA. Abstract 2308.