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Effects of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis for chemotherapy-induced febrile neutropenia in diffuse large B-cell lymphoma patients receiving the R-CHOP-21 regimen Cover

Effects of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis for chemotherapy-induced febrile neutropenia in diffuse large B-cell lymphoma patients receiving the R-CHOP-21 regimen

Open Access
|Aug 2025

Figures & Tables

Figure 1.

Survival analysis demonstrates FN-free survival probability (A) (HR = 0.48; 95% CI, 0.17–1.35) and event-free survival probability (B) (HR = 0.36; 95% CI, 0.16–0.84). 95% CI, 95% confidence interval; FN, febrile neutropenia; HR, hazard ratio.
Survival analysis demonstrates FN-free survival probability (A) (HR = 0.48; 95% CI, 0.17–1.35) and event-free survival probability (B) (HR = 0.36; 95% CI, 0.16–0.84). 95% CI, 95% confidence interval; FN, febrile neutropenia; HR, hazard ratio.

Clinical data, laboratory characteristics, and outcomes of patients with newly diagnosed DLBCL after all cycles of R-CHOP

Prophylaxis (N = 74)Non-prophylaxis (N = 29)P
Total cycles received6 (0)6 (0)0.483
Total treatment duration(d)108.5 (14)107 (8)0.395
Relative dose intensity (%)89.0 (14.2)91.1 (9.7)0.461
Complete remission (%)52 (70.3)19 (65.5)0.639
FN (%)11 (14.9)8 (27.6)0.134
Reactive G-CSF rescue (%)NA19 (65.5)NA
Chemotherapy discontinuation (%)6 (8.1)3 (10.3)0.718
Composite outcome (%)15 (20.3)14 (48.3)0.004
Hospitalization (%)16 (21.6)8 (27.6)0.567
ICU admission (%)1 (1.4)00.105

Clinical and laboratory characteristics of patients with newly diagnosed DLBCL before first R-CHOP

Prophylaxis (N = 74)Non-prophylaxis (N = 29)P
Age (years)63 (12)50 (15)<0.001
Male (%)32 (43.2)15 (51.7)0.437
Body weight (kg)60.1 (11.9)61.7 (12.3)0.53
Height (m)1.61 (0.09)1.62 (0.08)0.463
BMI (kg/m2)23.0 (3.4)23.2 (4.1)0.882
Hemoglobin (g/dL)11.5 (2.5)11.7 (2.3)0.742
WBC count (×109/L)8.62 (4.61)8.97 (5.79)0.749
ANC (×109/L)6.19 (4.22)5.84 (3.99)0.697
AMC (×109/L)0.67 (0.52)0.60 (0.53)0.582
Platelet count (×109/L)313.6 (160.0)330.2 (109.2)0.608
LDH (U/L)463.6 (493.5)488.6 (430.3)0.811
Creatinine (mg/dL)0.80 (0.27)0.71 (0.18)0.089
AST (U/L)36.0 (38.0)33.2 (25.8)0.717
ALT (U/L)33.9 (46.3)48.7 (76.8)0.24
Serum albumin (g/dL)3.8 (0.7)3.9 (0.6)0.363
Stage (1, 2, 3, 4)9, 23, 12, 305, 11, 1, 120.336
ECOG (0, 1, 2, 3, 4)20, 42, 9, 2, 011, 15, 1, 0, 00.341
IPI (L, LI, HI, H)15, 16, 26, 178, 10, 9, 20.18
Bone marrow involvement (%)9 (12.2)3 (10.3)0.779
Comorbidities (%)37 (50)8 (27.6)0.529
HBV Ag positive (%)3 (4.1)4 (13.8)0.071
Anti-HCV Ab positive (%)1 (1.4)0 (0)0.531
Anti-HIV Ab (%)1 (1.4)0 (0)0.526
CNS prophylaxis (%)26 (35.1)10 (34.5)1.00

Clinical and laboratory characteristics of patients with newly diagnosed DLBCL after first R-CHOP

Prophylaxis (N = 74)Non-prophylaxis (N = 29)P
FN650.177
Neutropenia (%)43 (58.1)15 (51.7)0.557
Grade 4 neutropenia (%)18 (24.3)7 (24.1)0.98
G-CSF rescue (%)NA10 (34.5)NA
Hemoglobin (g/dL)11.4 (2.1)11.0 (2.3)0.501
WBC count (×109/L)8.29 (10.44)5.88 (5.96)0.245
ANC (×109/L)7.13 (9.97)4.26 (3.07)0.029
AMC (×109/L)0.28 (0.47)0.07 (0.12)<0.001
Platelet count (×109/L)221.6 (161.2)287.8 (118.0)0.047

Risks associated with FN after R-CHOP

Odd ratio (95% CI)P
Age (years)≤35Reference
>35–500.18 (0.01, 2.32)0.187
>50–650.63 (0.11, 3.72)0.611
>651.04 (0.17, 6.26)0.963

Stage1Reference
21.26 (0.12, 13.25)0.848
35.78 (0.55, 60.61)0.144
44.61 (0.54, 39.49)0.163

Bone marrow involvementNoReference
Yes2.50 (0.67, 9.38)0.174

HBV carrierNoReference
Yes7.02 (1.42, 34.63)0.017

CNS prophylaxisNoneReference
Yes3.25 (1.18, 8.04)0.020

G-CSF prophylaxisNoneReference
Yes0.46 (0.17, 1.21)0.118
DOI: https://doi.org/10.2478/abm-2025-0021 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
Language: English
Page range: 165 - 173
Published on: Aug 31, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year

© 2025 Pannathorn Nakaphan, Noppacharn Uaprasert, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.