NEUTROPENIC COMPLICATIONS IN ADVANCED-STAGE NON-HODGKINS-LYMPHOMA - IMPLICATIONS FOR THE USE OF PROPHYLACTIC RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR (G-CSF)

Objectives: To determine the incidence of neutropenic complications in patients receiving chemotherapy for advanced-stage non-Hodgkin's lymp homa (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, be tween Jan. 1, 1992, and Dec. 31, 1993. Outcome measures: Neutropenic c omplications including incidence of febrile neutropenic events, docume nted infections, and chemotherapy dose delays or dose reductions. Resu lts: Of the 42 patients, 8 (19%) experienced febrile neutropenic event s and 18 (43%) required chemotherapy dose modifications (delays or red uctions or both) because of neutropenia. Fifteen patients (36%) were i dentified as being at high risk for neutropenic complications and may have benefited from the administration of prophylactic G-CSF. An econo mic model developed to assess the potential cost-effectiveness of prop hylactic G-CSF therapy estimated that, for high-risk patients, the the oretical incremental cost per life year saved was $3300. Conclusions: Febrile neutropenia and infection cause significant morbidity and mort ality 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 complicati ons and resulting increase in chemotherapy dose intensity received by patients on G-CSF, the theoretical incremental cost per life year save d of $3300 with G-CSF therapy is relatively low compared with other me dical interventions.