Isolated neutropenia during ABVD chemotherapy for Hodgkin lymphoma does not require growth factor support

Abstract

We reviewed the outcome of 24 patients with early and advanced stage Hodgkin lymphoma (HL) treated with ABVD chemotherapy (263 treatment deliveries) without the use of G-CSF over a 3-year period. Patients received full dose ABVD regardless of the absolute neutrophil count (ANC) on the day of treatment if there were no other cytopenias or toxicities. Forty-eight percent of treatment deliveries were given with an ANC <1.0 x 10(9)/L and 18% with an ANC <0.5 x 10(9)/L. Four patients required drug omissions (vinblastine or bleomycin) due to non-hematological side-effects. The rate of neutropenic sepsis was 0.76%. At a median follow up of 17.5 months, one patient had progressive disease requiring intensive treatment and the remainder were in remission post-treatment. Overall survival and event-free survival were 95.8% and 91.7%, respectively. We estimate a saving of 60,000 pounds in pharmaceutical and nursing expenditure related to G-CSF; a saving of 2000 pounds per patient. We conclude that full dose ABVD can be administered to patients with early and advanced stage HL irrespective of isolated neutropenia on the planned treatment day without prophylactic G-CSF or antibiotics and that this practise is safe, efficacious and cost-saving.

Guidelines for the first line management of classical Hodgkin lymphoma

“…ABVD should be delivered on schedule with infusions given every 14 d irrespective of neutrophil count. Granulocyte colony‐stimulating factor (G‐CSF) is only required for patients with infectious complications (Evens et al , ; Nangalia et al , ).…”

Neutropenia and Neutropenic Complications in ABVD Chemotherapy for Hodgkin Lymphoma

“…Neither GFs nor dose modifications were used to manage ABVD-related neutropenia in this study. In the second study by Nangalia et al, a total of 263 ABVD treatments (131.5 cycles) were delivered to 24 patients [34]. None of these patients received GFs and all patients received full dose of treatment irrespective of their ANC, provided no other cytopenias or toxicities were found on the day of treatment.…”

Chemotherapy only for localized Hodgkin lymphoma

“…Although the association with filgrastim has not been noted by others, most clinicians try to limit the amounts of filgrastim used in these patients based on this finding. The use of filgrastim or pegfilgrastim at all with ABVD is controversial [36–39], although filgrastim support is standard with more intensive regimens like escalated and dose‐intense BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) [40].…”