LATE ONSET NEUTROPENIA MAY BE A COMPLICATION OF FCR (or rituximab, obinutuzumab or other anti-CD20 monoclonal antibody infusions - Admin)

[zevkalman]

Here's another EHA abstract on the under-recognized issue of late-onset neutropenia as a result of FCR. I thought that this might be interesting to those of us on this site that have undergone or may undergo FCR. See the graph above. Someone can correct me if I am wrong, but my guess is that the take-away is that if you had Grade 3-4 Neutropenia during FCR you should be watched for late-onset neutropenia also. Also, there is a warning about GCSF support during chemotherapy (Granulocyte colony-stimulating factor).

By the way, here are all the EHA abstracts from last week:

ehaweb.org/congress-and-eve...

The paper:

LATE ONSET NEUTROPENIA IS A COMMON COMPLICATION OF FLUDARABINE, CYCLOPHOSPHAMIDE AND RITUXIMAB (FCR) THERAPY AND IS ASSOCIATED WITH SUBSTANTIAL MORBIDITY AND HOSPITALIZATION

Prahlad Ho* 1, Sarah Romero1, Thomas E. Lew2, Paul Turner1, John Seymour3, Carole Smith4, Dennis Carney3, Andrew Grigg1, Constantine Tam3

1Clinical Haematology, Austin Health, 2Faculty of Medicine, Nursing and Health Sciences, Monash University, 3Clinical Haematology, Peter MacCallum Cancer Centre, 4Austin Pathology, Austin Health, Melbourne, Australia

The conclusions:

Summary/Conclusion: Neutropenic complications, particularly LON, is an under-recognized and poorly reported complication of FCR. LON in pts receiving FCR is associated with high morbidity and frequent hospitalization. Pts who develop G3-4N during FCR chemotherapy are at high risk of subsequent LON, particularly if their chemotherapy was supported using GCSF. Our results demonstrate that the onset of G3-4N during FCR chemotherapy identifies pts at high risk for late neutropenic complications, and sound a cautionary note regarding the use of GCSF support during FCR therapy.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Admin Updates ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

This 2021 paper describes research that found that LON is about as common with obinutuzumab, as it is with rituximab

Late onset neutropenia after rituximab and obinutuzumab treatment - characteristics of a class-effect toxicity

- From a retrospective analysis 330 consecutive patients with lymphoproliferative neoplasms - not just CLL

pubmed.ncbi.nlm.nih.gov/342...

Febrile neutropenia was uncommon during LON and occurred in 15 patients (4.5%; rituximab (n = 14) and obinutuzumab (n = 1). These data suggest that LON after obinutuzumab treatment is as common as with rituximab.

Late-onset neutropenia after rituximab treatment: case series and comprehensive review of the literature (from 2010)

pubmed.ncbi.nlm.nih.gov/208...

We report 6 cases of LON identified in our institution. Four patients were treated for diffuse large B-cell lymphoma, and 2 patients for follicular lymphoma. Median patient age was 68 years (range, 33-83 yr); LON appeared after a median interval of 77 days (range, 42-153 d) and lasted for a median of 5 days (range, 1-45 d).

[AussieNeil Partner Administrator]

I presume the Y scale is the probability of late onset neutropenia (LON) occurring? So after a year, about 20% of FCR treated patients that didn't have Grade 3 - 4 neutropenia during treatment, have experienced late onset neutropenia, compared to more than double that if you did?

And I was so hoping not to be living with neutropenia after treatment

Neil

[zevkalman in reply to AussieNeil]

Neil, you will be OK. By the time you need treatment, they will be using a combination therapy that will essentially get rid of our monoclonal B-cells and we will all live happily ever after.