Dr Alison Moskowitz on Treatments More Likely to Cause Neutropenia in Hodgkin Lymphoma

While all treatment regimens for Hodgkin lymphoma can cause neutropenia, the degree and the chance of neutropenic fever varies, explained Alison J. Moskowitz, MD, medical oncologist, clinical director, lymphoma inpatient unit, Memorial Sloan Kettering Cancer Center.

Transcript

What treatments are more likely to cause patients with Hodgkin lymphoma to become neutropenic?

Standard ABVD [doxorubicin, bleomycin, vinblastine and darcarbacine] chemotherapy certainly causes neutropenia. The interesting thing about it, though, is that the rate of neutropenic fever with ABVD chemotherapy is very low. In fact, for young patients, who are the majority of patients with Hodgkin lymphoma, who are receiving ABVD chemotherapy, I typically do not give growth factor, unless they’ve had a history of having some trouble with getting admitted for neutropenic fever or trouble with infections.

In fact, it’s been shown that we can even treat these patients on time, despite the fact that they’re neutropenic when they come in to see us. I really advocate to try and keep their treatment on time, even if they’re neutropenic, because I think that has an important impact on making sure that we’re optimizing their chance of being cured.

When we bring in brentuximab to that regimen, so brentuximab plus ABVD regimen, it was a little bit of a surprise at first, but the rate of neutropenic fever was much higher than what is expected with ABVD. So, we learned that we have to give growth factor with that regimen, and so that is what I consider to be the standard of care.

The more intense regimen that we sometimes use for Hodgkin lymphoma, which is escalated BEACOPP, certainly has an even higher chance of causing neutropenic fever. We always use growth factor with that regimen. Despite that, some patients will get admitted for neutropenic fever. So, certainly all these regimens cause neutropenia. But, the degree and the chance of neutropenic fever, which is really what we’re trying to prevent when we’re giving growth factor, can vary a little bit.