Febrile neutropenia in adults with diffuse large B-cell lymphoma receiving first-line R-CHOP-based therapy: a systematic review and meta-analysis of observational and trial evidence.
Jamiel Reyes, Alexander Reyes
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In 30 seconds
This systematic review and meta-analysis assessed febrile neutropenia (FN) in adults with diffuse large B-cell lymphoma receiving first-line R-CHOP or R-CHOP-like therapy, separating observational cohorts from clinical trials. Across ten observational cohorts, pooled FN incidence was 19.0% (95% CI 17.1-21.1; I 2 = 34.0%). Five trials reported 11.7% (95% CI 5.7-22.7), with marked heterogeneity (I 2 = 79.4%). The difference between study designs was not statistically significant (p = 0.051) and depended substantially on one trial. The authors conclude that routine-practice incidence is approximately one in five.
Key findings
- Ten observational cohorts (4020 patients) had a pooled FN incidence of 19.0% (95% CI 17.1-21.1; I 2 = 34.0%).
- Five clinical trials (1,420 patients) reported FN incidence of 11.7% (95% CI 5.7-22.7), with substantial heterogeneity (I 2 = 79.4%).
- The difference between observational and trial estimates was not significant (p = 0.051) and depended substantially on one trial.
Why it matters
FN incidence informs assessment of supportive-care needs during first-line R-CHOP-based treatment. The observational estimate is close to the conventional 20% threshold cited for primary G-CSF prophylaxis, while trial estimates were lower and heterogeneous. Distinguishing evidence by study design helps clinicians interpret whether trial-derived rates reflect the burden seen in routine practice.
What to keep in mind
Trial estimates were markedly heterogeneous, and the comparison between study designs depended substantially on one trial.