Optimizing Dose-Adjusted EPOCH Chemotherapy with Long-Acting Granulocyte Colony-Stimulating Factor During the COVID-19 Epidemic

Introduction: Febrile neutropenia (FN) is a highly prevalent complication of chemotherapy. In this study, we aimed to evaluate the efficacy of polyethylene glycol recombinant granulocyte colony-stimulating factor (PEG-rhG-CSF) compared with short-acting rhG-CSF in the dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) regimen.

Patients and methods: A total of 66 patients with newly diagnosed aggressive B-cell lymphomas who received the rituximab combined with DA-EPOCH regimen and G-CSF support after chemotherapy were included in this study, including 33 patients in the PEG-rhG-CSF group during coronavirus disease (COVID-19) epidemic and another 33 matched patients in short-acting rhG-CSF group as historic control.

Results: The incidence of FN and FN-related hospitalization was significantly lower in chemotherapy cycles using PEG-rhG-CSF than in those using short-acting rhG-CSF (FN incidence: 10.4% vs 20.2%, P=0.038; incidence of FN-related hospitalization: 1.7% vs 7.3%, P=0.042). Overall, the incidence of dose-escalation and dose-reduction of the DA-EPOCH regimen was similar between these two groups.

Conclusion: Our findings suggest that PEG-rhG-CSF as a substitute for short-acting rhG-CSF in the DA-EPOCH regimen significantly reduced the incidence of FN and FN-related hospitalization, while simplifying neutropenia management for both patients and healthcare providers.