Sarcopenia attenuates the efficacy of PEGylated granulocyte colony-stimulating factor in preventing febrile neutropenia.

Purpose: The aim of this study was to develop a predictive model integrating sarcopenia, PEGylated granulocyte colony-stimulating factor (PEG-G-CSF) administration, and conventional risk factors to predict febrile neutropenia (FN) and grade 4 neutropenia (G4 NP) in patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP.

Methods: A retrospective cohort of 305 patients was analyzed. FN and G4 NP incidence rates after the first cycle were assessed along with predictors of these toxicities using multivariable logistic regression. Nomograms were developed and internally validated for risk prediction.

Results: PEG-G-CSF significantly reduced G4 NP incidence rates (37.3% vs. 53.3%) but had no significant effect on FN rates (20.9% vs. 17.1%). Sarcopenia was strongly associated with higher risks of FN (odds ratio [OR]: 3.568) and G4 NP (OR: 4.306), after adjusting for other clinical variables. Among patients with sarcopenia, the protective effect of PEG-G-CSF was attenuated, with persistently high FN and G4 NP incidence rates. For FN, the nomogram included age, albumin levels, lactate dehydrogenase levels, and sarcopenia. For G4 NP, the nomogram incorporated additional variables: sex and PEG-G-CSF use. Both models demonstrated good predictive accuracy. Sarcopenia and FN were associated with significantly reduced overall survival.

Conclusions: Sarcopenia may be a significant risk factor for FN, G4 NP, and reduced overall survival in patients with DLBCL receiving R-CHOP, and it may potentially diminish the protective effects of PEG-G-CSF. Predictive models for FN and G4 NP incorporating sarcopenia and other clinical factors may improve individualized treatment strategies, although further validation is needed.