Neutropenic complications in advanced-stage non-Hodgkin's lymphoma: implications for the use of prophylactic recombinant human granulocyte-colony stimulating factor (G-CSF)

Abstract

Objectives: To determine the incidence of neutropenic complications in patients receiving chemotherapy for advanced-stage non-Hodgkin's lymphoma (NHL), to predict which patients are at high risk for neutropenic complications and to develop an economic model for subsequent testing to assess the potential cost-effectiveness of prophylactic treatment with recombinant human granulocyte-colony stimulating factor (G-CSF).

Design: Retrospective chart review.

Patients: Forty-two patients with advanced-stage NHL treated at the Tom Baker Cancer Centre, Calgary, between Jan. 1, 1992, and Dec. 31, 1993.

Outcome measures: Neutropenic complications including incidence of febrile neutropenic events, documented infections, and chemotherapy dose delays or dose reductions.

Results: Of the 42 patients, 8 (19%) experienced febrile neutropenic events and 18 (43%) required chemotherapy dose modifications (delays or reductions or both) because of neutropenia. Fifteen patients (36%) were identified as being at high risk for neutropenic complications and may have benefited from the administration of prophylactic G-CSF. An economic model developed to assess the potential cost-effectiveness of prophylactic G-CSF therapy estimated that, for high-risk patients, the theoretical incremental cost per life year saved was $3300.

Conclusions: Febrile neutropenia and infection cause significant morbidity and mortality in patients receiving combination chemotherapy for the treatment of advanced-stage NHL. Secondary prophylactic G-CSF therapy has been proven to decrease the incidence of febrile neutropenia and infection in these patients. Considering the reduction in neutropenic complications and resulting increase in chemotherapy dose intensity received by patients on G-CSF, the theoretical incremental cost per life year saved of $3300 with G-CSF therapy is relatively low compared with other medical interventions.