The impact of age on delivered dose intensity and hospitalizations for febrile neutropenia in patients with intermediate-grade non-Hodgkin's lymphomareceiving initial CHOP chemotherapy: A risk factor analysis

The purpose of this historical case series study was to evaluate the associ ation of age on delivered dose intensity of initial CHOP (cyclophosphamide/ doxorubicin/vincristine/prednisone) chemotherapy and the occurrence of hosp italizations for febrile neutropenia for patients with intermediate-grade n on-Hodgkin's lymphoma (NHL). Findings are reported for 12 managed community and academic practices. Medical records of 930 NHL patients not enrolled o n clinical trial protocols were reviewed. We reported on 577 of the study p atients (62%) who received initial CHOP chemotherapy. Median age of the pat ients was 65.1 years. Older patients (age greater than or equal to 65 years ) had more hospitalizations for febrile neutropenia (28% vs. 16%; P < 0.05) than younger patients (age, 18-64years). In patients with advanced-stage N HL (stage III/IV), older patients received fewer cycles of CHOP (< 6 cycles , 35% vs. 22%; P < 0.05) than younger patients. Older patients were planned for lower average relative dose intensity (ARDI less than or equal to 80%; P < 0.05) and had more heart disease and comorbid conditions (P < 0.05) th an younger patients. Multiple logistic regression models showed that older patients were more likely to receive a lower dose intensity (ARDI less than or equal to 80%; odds ratio = 2.46, 95% confidence interval [CI]: 1.62-3.7 2) during their first 3 cycles of therapy and to experience more hospitaliz ations for febrile neutropenia (odds ratio = 2.17, 95% CI: 1.43-3.30). We f ound the dose intensity of delivered CHOP chemotherapy for elderly patients to be less than standard CHOP therapy and the risk of hospitalizations for febrile neutropenia to be greater than in younger patients. Prospective cl inical trials examining supportive care measures, such as colony-stimulatin g factor, for elderly NHL patients are recommended.