Patterns of chemotherapy administration in patients with intermediate-grade non-Hodgkin's lymphoma

• Published in: Oncology (Williston Park, N.Y.) Vol. 15; no. 10; p. 1296
• Main Authors: Picozzi, V J, Pohlman, B L, Morrison, V A, Lawless, G D, Lee, M W, Kerr, R O, Ford, J M, Delgado, D J, Fridman, M, Carter, W B
• Format: Journal Article
• Language: English
• Published: United States 01.10.2001
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Disease-Free Survival; Dose-Response Relationship, Drug; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Female; Growth Substances - therapeutic use; Humans; L-Lactate Dehydrogenase - analysis; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - enzymology; Male; Middle Aged; Mitoxantrone - administration & dosage; Mitoxantrone - adverse effects; Neutropenia - chemically induced; Prednisolone - administration & dosage; Prednisolone - adverse effects; Prednisone - administration & dosage; Prednisone - adverse effects; Reference Values; Retrospective Studies; Severity of Illness Index; Time Factors; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 0890-9091

Records from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-Hodgkin's lymphoma (NHL). Of the 653 patient records reviewed, 90 (14%) omitted an anthracycline or mitoxantrone (Novantrone) from primary therapy. Among patients receiving CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) or CNOP (cyclophosphamide, mitoxantrone, vincristine, prednisone), 134 (27%) of 492 received an average relative dose intensity of less than 80% of the literature-referenced dose, due either to an inadequate planned or delivered dose. Of 181 advanced-stage patients with responsive disease, 28 (15%) failed to receive at least six treatment cycles. Overall, 283 (43%) of 653 patients potentially received suboptimal chemotherapy due either to choice of regimen or chemotherapy delivered. Patient age > or = 65 years and cardiac comorbidity appeared to have the greatest influence on a physician's decision regarding chemotherapy administration. Among the 492 patients who received CHOP or CNOP, 235 (48%) experienced a delay or reduction in chemotherapy dose (usually neutropenia-related), 100 (20%) developed mucositis, and 116 (24%) were hospitalized for febrile neutropenia. Growth factor was administered to 261 patients (53%), and its primary prophylactic use was associated with a significant reduction in the incidence of hospitalizations for febrile neutropenia in all patient subgroups receiving appropriate chemotherapeutic dose intensity (P = .02). This assessment of chemotherapy delivery to patients with intermediate-grade NHL showed significant variation from current standards. Further analysis of factors influencing chemotherapy delivery might improve therapeutic outcomes.