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Posted by on Jun 25, 2019 in Hodgkin's lymphoma | 0 comments

In a nutshell

This article reviewed the risk of patients with advanced Hodgkin lymphoma (HL) developing neutropenia after first-line treatment. This study concluded that this condition can be a serious complication for these patients.

Some background

The most commonly used frontline chemotherapy regimens for advanced HL are ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone). One common complication of these regimens is a condition called neutropenia. Neutropenia is characterized by abnormally low levels of neutrophils (white blood cells) in the blood. This makes patients more prone to infections.

Severe neutropenia with or without fever can be life-threatening. G-CSF (granulocyte-colony stimulating factor; Filgrastim) treatment is often recommended for patients at risk for neutropenia. This treatment increases neutrophil levels to help prevent neutropenia during chemotherapy. It is important to research the risk of developing neutropenia in patients treated for HL.

Methods & findings

Brentuximab vedotin (Adcetris) is a new treatment being investigated for the treatment of advanced HL. Brentuximab vedotin is a monoclonal antibody. This type of treatment binds to cancer cells. This leads to cancer cell death. This agent is being investigated in combination with chemotherapy.

In a phase 1 study, patients with advanced HL received a chemotherapy regimen called A+AVD. This regimen is the same as ABVD, but without bleomycin (Blenoxane). Brentuximab vedotin replaces bleomycin to decrease side effects. 84% of patients in this study received G-CSF treatment. Fewer patients treated with A+AVD developed neutropenia with fever compared to patients treated with brentuximab vedotin plus ABVD (8% vs. 20%).

In a phase 3 study, 1334 patients with advanced HL were treated with A+AVD or ABVD. More patients treated with A+AVD developed neutropenia with fever compared to patients treated with ABVD only (19% vs. 8%). 83 patients in the A+AVD group were given G-CSF treatment. Neutropenia with fever occurred significantly less often in these patients compared to patients who did not receive G-CSF (11% vs. 21%). The risk of tumor growth or spread was also 25% lower in these patients.

The bottom line

This study concluded that neutropenia can be a serious complication for patients with advanced HL. The authors suggest that routine G-CSF treatment can lower the risk of neutropenia and improve treatment outcomes.

What’s next?

Talk to your doctor if you have questions about the risks of developing neutropenia after first-line treatment.

Published By :

Critical reviews in oncology/hematology

Date :

Jun 01, 2019

Original Title :

Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management.

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