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

Records from 653 patients treated between 1991 and 1998 in the Oncology Pra ctice Patterns Study (OPPS) were analyzed to determine contemporary chemoth erapy delivery patterns in patients with intermediate-grade non-Hodgkin's l ymphoma (NHL). Of the 653 patient records reviewed, 90 (14%) omitted an ant hracycline or mitoxantrone (Novantrone) from primary therapy. Among patient s receiving CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vinc ristine [Oncovin], prednisone) or CNOP (cyclophosphamide, mitoxantrone, vin cristine, prednisone), 134 (27%) of 492 received an average relative dose i ntensity of less than 80% of the literature-referenced dose, due either to an inadequate planned or delivered dose. Of 181 advanced-stage patients wit h responsive disease, 28 (15%)failed to receive at least six treatment cycl es. Overall, 283 (43%) of 653 patients potentially received suboptimal chem otherapy due either to choice of regimen or chemotherapy delivered. Patient age greater than or equal to 65 years and cardiac comorbidity appeared to have the greatest influence on a physician's decision regarding chemotherap y administration. Among the 492 patients who received CHOP or CNOP, 235 (48 %) experienced a delay or reduction in chemotherapy dose (usually neutropen ia-related), 100 (20%) developed mucositis, and 116 (24%) were hospitalized for febrile neutropenia. Growth factor was administered to 261 patients (5 3%), and its primary prophylactic use was associated with a significant red uction 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 intermedia te-grade NHL showed significant variation from current standards. Further a nalysis of factors influencing chemotherapy delivery might improve therapeu tic outcomes.