Meta-Analysis of Risk Factors and Incidence of Interstitial Pneumonia With CHOP-Like Regimens for Non-Hodgkin Lymphoma

Abstract

ObjectivesInterstitial pneumonitis (IP), a potentially fatal complication of non-Hodgkin Lymphoma (NHL) patients received CHOP (cyclophosphamide and doxorubicin and vincristine and prednisone)-like chemotherapy, negatively affected patients’ clinical outcome and quality of life. We aimed to explore patient-related, disease-related and drug-related risk factors associated with IP and gain a better understanding of the incidence in NHL patients.MethodsDatabases, including PubMed, Ovid, China National Knowledge Internet (CNKI), and Wanfang Database from inception to January 20, 2022, were searched to identify studies evaluating the risk factors and incidence of IP. The included studies were assessed by Newcastle-Ottawa Quality Scale and above 7 points was considered high quality. The statistical analysis of risk factors was assessed by RevMan software (version 5.3) and incidence of IP was calculated by R software (version 4.1.2). Fixed-or random-effects models were applied to estimated the relative risks (RRs) and 95% confidence interval (Cl).ResultsA total of 12 studies comprised of 3423 NHL patients were included in the analysis. Among the 3 available patient-related risk factors, 6 disease-related risk factors and 3 drug-related risk factors, it was found that only drug-related risk factors were significantly associated with IP development: pegylated liposomes doxorubicin (PLD) replacement (RR = 3.25, 95% CI = 1.69-6.27, I2 =64%), rituximab (RTX) addition (RR = 4.24, 95% CI = 2.58-6.96, I2 =0) and granulocyte colony stimulating factor (G-CSF) administration (RR = 5.80, 95% CI = 3.05-11.05, I2 =0). The pooled incidence of CHOP, R-CHOP, and R-CDOP regimen was 1.0% (95% CI 0.00-0.01, I2 = 8%), 7.0% (95% CI 0.05-0.09, I2 = 64%) and 22.0% (95% CI 0.13-0.32, I2 = 87%) respectively.ConclusionPLD replacement, RTX addition and G-CSF administration were significant risk factors of IP for NHL patients received the CHOP-like chemotherapy. Clinicians should focus on these patients to detect and treat the IP development timely, which might bring benefit in patients’ survival.Systematic Review RegistrationPROSPERO, identifier CRD42022309884.

A case of diffuse large B-cell lymphoma with interstitial pneumonia

“…Literature reports have shown that rituximab can cause IP. Wang Qian et al., 3 statistics showed that the incidence of IP in the R-CHOP group was 14.8%, which was significantly higher than the 2.4% incidence in the CHOP group. Other studies have also reported incidences ranging from 3.7% to 16.7%.…”

“…2 The reported incidence of IP in various studies varies greatly, ranging from 0.03% to 29.0%. 2 , 3 , 4 …”

“…In a recent domestic study conducted by Zhu Jun et al., 5 data from 2212 patients collected between 2009 and 2014 revealed an incidence of IP was 32.4% (76/1925) in NHL ( P ​= ​0.210). Accordingly, a meta-analysis 6 encompassing 12 studies and analyzing 3423 NHL patients found that among the three available patient-related risk factors (age, sex, and smoking habit), six disease-related risk factors (pathological type, Ann Arbor stage, IPI score, lactate dehydrogenase level, serum β2-microglobulin, B symptoms), and three drug-related risk factors (doxorubicin liposome replacing doxorubicin, combined with rituximab, and granulocyte colony-stimulating factor used in the treatment), only drug-related risk factors were found to be significantly related to IP development. The average incidence rates of IP in the CHOP, R-CHOP, and R-CDOP schemes were 1.0%, 7.0%, and 22.0%, respectively.…”

“…In addition, Qian et al. 3 found that male smokers and those with B symptoms might also be at an increased risk of developing IP.…”