Neutropenic and Non-Neutropenic Fever In Diffuse Large B-Cell Lymphoma Patients Treated With Rituximab-CHOP Chemotherapy

Rituximab-CHOP (R-CHOP) is the standard chemotherapy in DLBCL patients. Febrile neutropenia (FN) is the major toxicity of this regimen, but we also observe non-neutropenic fever (NNF) during the recovery period after R-CHOP.

Between September 20089 and January 2013, a total of 1142 lymphoma patients were registered in the prospective cohort. Among these, 397 DLBCL patients who had completed R-CHOP based chemo cycles as first line treatment were analyzed.

Of the 397 patients, 160 (40.3%) and 39 (9.8%) experienced FN and NNF, and 24 (6.0%) exhibited both. Approximately 50% of the initial FN occurred after the 1st cycle whereas NNF was mainly observed around the 4th cycle (28.2%). Including multiple FN occurrences in 65 patients (40.9%), there were 276 FN events in 160 patients. Besides unexplained fever (47.8%), catheter related infection was predominated (14.2%) and Coagulase negative staphylococcus was the most common microorganism causing bacteremia (27.7%). Thirty nine patients with NNF exhibited a total of 42 episodes and atypical pneumonia comprised the highest proportion (54.8%). Of the identified organisms causing atypical pneumonia, PJP was most common (n=4), adenovirus (n=3), RSV (n=2), and CMV (n=1) came next.

FN and NNF during R-CHOP treatment showed different clinical manifestation regarding their timing of initial episode and causes.

No relevant conflicts of interest to declare.