Long-acting lipegfilgrastim and antimicrobials as vigorous primary prophylaxis in bendamustine-treated patients with indolent B cell non-Hodgkin lymphoma: a multicentric real-life experience

Febrile neutropenia (FN) is one of the most important clinical signs of infection, especially for older patients with indolent B cell non-Hodgkin lymphomas (iBC-NHLs) receiving frontline immune-chemotherapy with bendamustine-rituximab (BR). Data on the optimal strategy for infection prophylaxis from the start of chemotherapy until 1 month after the last cycle is scanty in this setting of patients, and for this reason, we carried out a multicentric retrospective study on vigorous primary anti-infectious prophylaxis consisting of lipegfilgrastim, trimethoprim-sulfamethoxazole, and acyclovir. From January 2017 to January 2022, 200 patients met the inclusion criteria and were enrolled in the final analysis. As per the primary endpoint, during the immune-chemotherapy period, the overall incidence of FN was 6% consisting of fever of unknown origin (2%), clinically documented infections (2.5%), and microbiologically documented infections (1.5%). Chemotherapy disruption for a delay of at least 1 week related to FN that required hospitalization was recorded in 1% of patients (n = 2). Prophylaxis was well tolerated with grade 3 toxicity (bone pain) in only 10% of patients and was successfully managed with paracetamol or tramadol. Systematic, prompt, and sustained use of vigorous primary anti-infectious prophylaxis was able to reduce the rate of fever episodes, thus averting parenteral antimicrobial administrations, hospitalizations, and immune-chemotherapy disruption.