Key clinical point: Several phase 3 trials have demonstrated different rates of febrile neutropenia between regimens.

Major finding: Prophylactic granulocyte-colony stimulating factor is recommended for intensive regimens.

Study details: Review of 5 RCT that studied clinical outcomes and infection rates in previously untreated patients with DLBCL.

Disclosures: The study was unsponsored and the authors reported having no conflicts.

Commentary

“The majority of patients with diffuse large B-cell lymphoma (DLBCL) are treated with R-CHOP in the frontline setting. Certain subtypes including primary mediastinal B-cell lymphoma, double hit lymphoma, and patients with HIV and DLBCL may receive the infusional regimen DA-EPOCH-R. Those patients who are relapsed or refractory to frontline therapy are typically treated with R-ICE or R-DHAP followed by autologous stem cell transplant in responders. Prophylactic granulocyte colony stimulating factors can be given to minimize risk of febrile neutropenia and associated complications. The authors reviewed 5 randomized clinical trials and concluded that those patients treated with DA-EPOCH-R, R-ICE or R-DHAP should receive prophylaxis against febrile neutropenia including pegfilgrastim or similar agents.”

Sarah Rutherford, MD

Assistant Professor of Medicine, Weill Cornell Medicine