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Chemotherapy used to treat lymphoma can cause severe neutropenia. Risk models have identified factors that predict neutropenia across all chemotherapy cycles. We used clinical information obtained during pretreatment evaluation to develop a predictive model for severe neutropenia in the first cycle of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy. This case series study included lymphoma patients receiving CHOP chemotherapy with or without rituximab who did not receive pre-emptive hematopoietic growth factor. Risk factors for neutropenia were identified from previously published models and included age ≥65 years, hypoalbuminemia, renal/cardiovascular disease, anemia, abnormal bone marrow and increased lactate dehydrogenase (LDH). A composite score equal to the number of pretreatment risk factors was used to predict severe neutropenia in cycle 1. Fifty-three percent of patients (47 of 89) had severe neutropenia, with 70% of first episodes occurring during cycle 1. Eighty-two percent of first-cycle, severe neutropenia events occurred in patients ≥65-years-old. In univariate analysis, age ≥65 years and increased baseline LDH were significantly associated with increased risk for severe neutropenia in cycle 1. In logistic regression modeling, the probability of severe neutropenia in cycle 1 increased as the number of pretreatment risk factors increased, with a one-unit increase in risk score resulting in a 2.3-fold increase in severe neutropenia. The study results suggest that data obtained before initiating CHOP-based chemotherapy can be used to identify those patients who are at risk for severe neutropenia in cycle 1. If validated, our model could be used to identify patients who would benefit from early use of growth factors. [ABSTRACT FROM AUTHOR]

This study investigated the incidence of anemia in chemotherapy-treated intermediate-grade nonHodgkin's lymphoma (IGNHL) patients. A historic case series design was used. The study data were obtained from 12 oncology practices that participated in the Oncology Practice Pattern Study (OPPS). The analysis focused on 353 IGNHL patients with normal baseline (prechemotherapy) hemoglobin (Hb) (≥ 12.0 g/dL). These patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone combination) therapy (at some point) from 1993 through 1999. Anemia was found to be prominent during chemotherapy. About 24% of the patients with a normal baseline Hb level dropped below 10.0 g/dL and 49% dropped to 10.0 -11.9 g/dL, at some point during chemotherapy. As anemia treatment data were unavailable, it is likely that some of these patients received therapy to boost their Hb levels, rendering our results conservative. A logistic regression model revealed that in patients with normal baseline Hb, age ≥ 60, female gender, lower baseline Hb level, and lymphoma histology classified as the Working Formulation (WF) E or H were significant predictors of a drop in Hb below 10.0 g/dL during chemotherapy. Chemotherapy-induced anemia is frequently observed in lymphoma patients. It is possible to identify adverse baseline patient characteristics associated with higher risk of chemotherapy-induced anemia and carefully monitor such patients. Additional studies in community oncology practice are warranted to validate these findings and improve our understanding of the problems of anemia in chemotherapy treated non-Hodgkin's lymphoma (NHL) patients. J Oncol Pharm Practice (2002) 8, 73-80. [ABSTRACT FROM AUTHOR]