Research ArticleClinical Studies

Usefulness of Medication Guidance Sheets for Patients With Non-Hodgkin’s Lymphoma Receiving ESHAP±R Therapy

MAYAKO UCHIDA, SAEKO MURATA, HANAE MORIKAWA, HIROKO YONEMITSU, SHIGERU ISHIDA, KIMITAKA SUETSUGU, TOSHIKAZU TSUJI, HIROYUKI WATANABE, TAKEHIRO KAWASHIRI, KOJI KATO, KEIKO HOSOHATA, TOSHIHIRO MIYAMOTO, NOBUAKI EGASHIRA, TSUTOMU NAKAMURA, KOICHI AKASHI and ICHIRO IEIRI
Anticancer Research April 2022, 42 (4) 2053-2060; DOI: https://doi.org/10.21873/anticanres.15686

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Abstract

Background/Aim: The occurrence of chemotherapy-related serious adverse events (AEs) is associated with a poor prognosis of hematopoietic malignancies. We have developed a medication guidance sheet (MGS) for monitoring AEs occurring when combining chemotherapy with etoposide, methylprednisolone, cisplatin, cytarabine, and rituximab (ESHAP±R). In this study, the usefulness of MGS was investigated in non-Hodgkin’s lymphoma patients. Patients and Methods: The MGS was used to monitor AEs in 48 adult patients receiving ESHAP±R. The prediction accuracy of the MGS was estimated before and after modification based on practical data. Results: A total of 246 AEs developed, all of which were predicted by the MGS. Among them, 149 events (61%) occurred during the same period as those predicted by the MGS. After modification of MGS for the onset and duration of AEs, the accuracy increased to 84%. Conclusion: The accuracy of the original MGS for ESHAP±R was insufficient but greatly improved after the AEs duration modification.

Key Words:

In hematopoietic malignancy, high-dose chemotherapy is commonly performed to achieve complete remission of the disease. Vincristine-based chemotherapy regimens such as cyclophosphamide, doxorubicin, vincristine, and prednisolone and cyclophosphamide, vincristine, and prednisone are representative first-line chemotherapy for non-Hodgkin’s lymphoma (NHL) (1–3), Platinum- and cytarabine-based chemotherapy regimens, including etoposide, methylprednisolone, cisplatin, and cytarabine (ESHAP) with or without rituximab, have been shown to be effective second-line therapies for recurrent or refractory NHL (4–7).

Despite the clinical effectiveness of such chemotherapy regimens, a variety of adverse events (AEs) develop at different times of onset, leading to the impairment of patients’ quality of life, reduction in the relative dose intensity, discontinuation of therapy, and poor clinical outcomes (8–10). Therefore, extensive care should be taken to avoid or relieve serious AEs during combination chemotherapy. In this respect, medical professionals, including clinical pharmacists, are responsible for verification of the prescription orders based on the chemotherapy regimen, provision of safe and effective supportive care medications, and extensive explanation to patients regarding the onset, degree of symptoms, and duration of AEs that are likely to occur in order to ensure safe and effective chemotherapy and to relieve patient anxiety (11–17).

We have developed innovative medication guidance sheets (MGSs) covering 300 chemotherapy regimens, based on the data in the package inserts, manufacturers’ brochures, and literature to ensure the rapid and accurate monitoring of AEs that will occur during combination chemotherapy (11). These sheets enabled not only medical professionals, including pharmacists, physicians, and nurses, but also patients to understand visually and promptly what types of AEs occurred, to what extent they occurred, when the symptoms appeared, and for how long they continued. However, it is still uncertain whether the MGSs cover all AEs from the aspect of AE items, timing of onset, and duration of symptoms. Therefore, a reliable MGS is required for precise monitoring of AEs, since various grades of AEs appear at different times and have varying durations during cancer chemotherapy.

In the present study, the prediction accuracy of the MGS prepared for ESHAP±rituximab (ESHAP±R) chemotherapy was evaluated in patients with NHL. Subsequently, the MGS was modified based on practical data to ensure more accurate and reliable monitoring of AEs associated with ESHAP±R in clinical settings.

Patients and Methods

ESHAP±R therapy. The ESHAP±R regimen included etoposide (40 mg/m2, intravenous infusion for 1 h) on days 2 to 5, followed by methylprednisolone (500 mg/body, intravenous injection for 30 min) on days 2 to 6, cisplatin (25 mg/m2, intravenous infusion for 24 h) on days 2 to 5, and cytarabine (2 g/m2, intravenous infusion for 3 h) on day 6 with or without rituximab (375 mg/m2, intravenous infusion for 3-6 h on day 1) for one cycle and was administered every 28 days. ESHAP-R was administered to 27 patients, while ESHAP was administered to 21 patients.

Medication guidance sheet (MGS). An MGS template was prepared using Microsoft Excel® 2010 and later version on the Microsoft Windows platform, which consisted of two parts: the treatment schedule section and the AE monitoring section during cancer chemotherapy (Figure 1). The incidence rate of each AE associated with etoposide, methylprednisolone, cisplatin, cytarabine, or rituximab was cited from the package insert and manufacturers’ brochures. AEs with incidence rates greater than 10% were listed in the MGS as those that should be monitored by medical professionals. Data on the onset and duration of the listed AEs were referenced from the literature (18, 19) and our previous retrospective study (20). The onset timings and durations of AEs were marked with color to promptly and visually recognize the AEs that require extensive care. Myelosuppression should be monitored carefully, since chemotherapy increases the risk of death due to infection associated with neutropenia and hemorrhage related to thrombocytopenia (21, 22). The periods of monitoring of leukopenia, thrombocytopenia, and anemia were set starting from 12 days after chemotherapy until recovery to the normal range. The dosage and administration of drugs for premedication and supportive care were listed in the MGS, where brief explanations and speech bubbles were inserted. These items were obtained after the approval of oncology specialists in our department of hematology. Illustrations inserted in the MGS were originally drawn by pharmacists in the Department of Pharmacy at Kyushu University Hospital.

Figure 1.
Figure 1.

A MGS for ESHAP±R therapy. The upper part shows the names of drugs for supportive care and cancer chemotherapy, and treatment schedule, while the lower represents the predicted AEs and their onset and duration. A brief explanation for each AE is also described. The MGS was arranged to fit a 4-week cycle schedule in one sheet according to the treatment regimen. Modifications were made with respect to the onset and duration of anorexia, stomatitis, leukopenia, thrombocytopenia, and decrease in hemoglobin, as shown by the shaded column. AE: Adverse event; MGS: medication guidance sheet; ESHAP±R: etoposide, methylprednisolone, cisplatin, cytarabine±rituximab.

Assessment of MGS. Patients aged 20 years or older who received ESHAP±R therapy as salvage treatment for relapsed/refractory NHL at the Department of Hematology, Kyushu University Hospital, Fukuoka, Japan, from April 2011 to March 2019 were included. Physicians, nurses, and pharmacists monitored AEs by using the MGS for ESHAP±R and verified the prescription of supportive care medicines when any sign of AEs appeared. AEs were graded according to the Common Toxicity Criteria, version 4.0, (National Cancer Institute, Bethesda, MD, USA).

Modification of MGS. Based on the present real-world data on the incidence, rate, and duration of AE symptoms in NHL patients treated with ESHAP±R, the timing of MGS events was revised. Specifically, the onset times of non-hematological AEs were adjusted for leukopenia, thrombocytopenia, decreased hemoglobin, stomatitis, and anorexia.

Ethics approval statement. This study was conducted with the approval of Osaka University of Pharmaceutical Sciences (approval no. 2020-0077 of the institutional review board) and with the approval of the Kyushu University Graduate School and Faculty of Medicine (approval no. 2019-352 of the institutional review board).

Data analyses. The predictive accuracy of the present MGS was evaluated by calculating the rate of matching of each AE item observed in the present study with the incidence and duration predicted by the MGS. Data are shown as the matching rate and 95% confidence interval for the population proportion, according to the report by Rumsey (23). Spearman’s rank-order analysis was used to determine the relationship between the grade of symptoms and the rate of prediction accuracy. The rates of predictive accuracy were statistically compared before and after modification of the MGS by the non-parametric test for analysis of paired nominal data (McNemar test). Data were analyzed using JMP Pro® 16 (SAS Institute, Cary, NC, USA).

Results

Patient baseline clinical characteristics. A total of 48 patients, all Japanese with NHL, were included in this study. The baseline clinical characteristics of the patients are shown in Table I. Males accounted for 56.3% of the patients. The median age of the patients was 61 years (range=30-72 years). Most of them showed a good performance status (0-1). Although the median counts of leukocytes or neutrophils were normal, the low counts of leukocyte below the lower limit of normal were observed in 14 patients (29.2%), even before the start of chemotherapy. The low hemoglobin contents (<10×104/μl) were observed in 22 patients (45.8%). The most common disease was diffuse large B-cell lymphoma (58.3%), followed by follicular lymphoma (16.7%), and adult T-cell leukemia/lymphoma (6.3%).

View this table:
Table I.

Patient characteristics.

Evaluation of MGS for prediction of AE items and their onsets and durations. As shown in Table II, a total of 246 events were monitored in 48 patients, including 34 patients with anorexia (incidence rate of 70.8%), 29 elevation of aspartate aminotransferase (60.4%), 25 elevation of alanine aminotransferase (52.1%), 27 nausea/vomiting (56.3%), 19 diarrhea (39.6%), 11 elevation of serum creatinine (22.9%), 8 insomnia (16.7%), 7 stomatitis (14.6%), and 3 infusion reactions (11.1%) for non-hematological AEs and 42 leukopenia (87.5%), 36 thrombocytopenia (75.0%), and 5 decreased hemoglobin (10.4%) for hematological AEs.

View this table:
Table II.

Prediction accuracy of MGS in the incidence of various grades of hematologic and non-hematologic AEs in patients who received ESHAP±R chemotherapy.

Notably, all of these AEs were predictable AEs that were listed in the MGS. Among these events, 149 events (60.6%) occurred during the same period as those described in the MGS. In particular, the onset timings of the increase in serum creatinine and infusion reaction were all exactly the same as those listed in the present MGS. There was a significant correlation between the grade of symptoms and the rates of prediction accuracy, with an accuracy rate of 79.2% (99 of 125 events) for grade 1, 64.3% (27 of 42) for grade 2, 38.7% (12 of 31) for grade 3, and 22.9% (11 of 48) for grade 4 (Spearman’s coefficient of correlation=0.994, p=0.006).

As shown in Table III, the accuracy of the MGS for prediction of the onset and duration of AEs was 100% for elevation of serum creatinine and infusion reaction and sufficiently high for nausea/vomiting [85.2%,95% confidence interval (CI)=66.3-95.8%], elevation of alanine aminotransferase (80.0%, 95%CI=58.8-93.6%), and elevation of aspartate aminotransferase (75.9%, 95%CI=56.5-89.7%). However, the rate of accuracy was insufficient for stomatitis (42.9%, 95%CI=9.9-81.6%) and hematological AEs such as a decrease in hemoglobin (20.0%,95%CI=0.5-71.6%), leukopenia (28.6%, 95%CI=15.7-44.6%), and thrombocytopenia (41.7%, 95%CI=25.5-59.4%).

View this table:
Table III.

Accuracy rates of the MGS for prediction of the onset of each AE in patients receiving ESHAP±R chemotherapy: Comparison before and after modification of MGS.

Unpredicted AEs such as anorexia, nausea/vomiting, insomnia, and stomatitis appeared later than the respective timing listed in the MGS, whereas other AEs, including elevation of serum aminotransferases and hematological AEs, developed earlier than expected.

Changes in the accuracy rates in predicting the onset and duration of AEs after modification of MGS based on the practical data. Since the rates of predictive accuracy regarding the onset and duration of hematological AEs were low (20%-41.7%), the predicted onset and duration of such AEs were modified, as shown in Figure 1. The time of initiation of monitoring leukopenia and thrombocytopenia changed from the 12th day to the 5th day of chemotherapy. In case of the decrease in hemoglobin content, monitoring was started on the 7th day rather than on the 12th day of chemotherapy. The revisions for non-hematological AEs were confined to stomatitis and anorexia. In either case, the time of ending, rather than the start of monitoring, was changed to until recovery to normal.

Comparison of prediction accuracy before and after MGS modification. The accuracy rates increased significantly after MGS modification from 28.6% to 90.5% (p<0.001 by McNemar test) for leukopenia and from 41.7% to 83.3% (p<0.001) for thrombocytopenia (Table III). In addition, the predictive accuracy for stomatitis and anorexia reached 100% after revision of the MGS. Overall, the accuracy of the revised MGS for the prediction of any AE increased significantly from 60.6% to 84.2% (p<0.001).

Discussion

The original MGS rate of prediction accuracy for the onset and duration was 60.6% (95%CI= 54.2-66.7). Moreover, in 149 events of 246 AEs, the onset timing and duration of these AEs were consistent with those described in the MGS. This value was considerably lower than that (81.6%) reported previously in patients with ovarian cancer who received paclitaxel and carboplatin (TC) combination chemotherapy (17). Although the precise reason for such an inconsistency remains unclear, differences in the patients’ characteristics, such as pathological background, sex and age, and/or differences in the intensity of chemotherapy regimens between ESHAP±R (4-5 chemotherapy agents administered for 6 days) and TC (2 agents injected on day 1 only), may explain the above-mentioned inconsistency.

Notably, the prediction accuracy rate of the original MGS was 100% for the elevation of serum creatinine and the infusion reaction. The onset timing of nausea/vomiting and serum alanine aminotransferase was also highly predictable, with an accuracy rate of 85.2% (95%CI=66.3-95.8%) and 80.0% (95%CI=58.8-93.6%), respectively. In contrast, the prediction of hematological AEs was rather insufficient, in which the prediction accuracy rate was 20.0% (95%CI=0.5-71.6%) for the decrease in hemoglobin, 28.6% (95%CI=15.7-44.6%) for leukopenia, and 41.7% (95%CI=25.5-59.4%) for thrombocytopenia. Unpredicted hematological AEs such as the reduction in hemoglobin content (four events) developed in all cases earlier than the predicted onset timing. One possible reason for this is that low white blood cell counts and low hemoglobin levels were found in 29.2% and 45.8% of patients, respectively, before the start of chemotherapy. Therefore, it is likely that myelosuppression occurred earlier than expected. It has been demonstrated that several risk factors, including old age, a history of previous chemotherapy, or bone marrow involvement with tumor, are present in the development of leukopenia or febrile neutropenia (24, 25). In contrast, Conlan et al. (26) reported that in NHL patients, chemotherapy-induced leukopenia and thrombocytopenia were largely affected by the involvement of bone marrow in the pathogenesis. This may complicate the incidence prediction of hematological AEs (27).

Among the non-hematological AEs, stomatitis had the lowest prediction accuracy rate (42.9%). The onset timing of stomatitis was mostly within the expected range; however, the duration was longer than predicted (during 4 and 15 days). Anorexia, the most popular non-hematological AE in our data, also appeared for a longer duration than expected (during 2 and 10 days).

Based on the present clinical data, the original MGS was modified with respect to the onset and duration of hematological AEs, stomatitis, and anorexia. As a result, the prediction accuracy was significantly improved for hematological AEs (85.5% vs. 33.7%, p<0.001) and anorexia (100% vs. 64.7%, p<0.01), although the rate of stomatitis increased, but not significantly (100% vs. 42.9%, p=0.133). Thus, the rate of prediction accuracy for the total AEs increased significantly (p<0.001) from 60.6% (before modification) to 84.2% (after modification).

Serious AEs associated with cancer chemotherapy result in a reduction in patients’ quality of life; thus, cancer patients are more or less anxious about what types of AEs occur and when they appear. Particularly, in patients with relapsed and refractory NHL who receive intensive chemotherapy, the anxiety of the incidence of AEs as well as the therapeutic efficacy would be extremely serious.

In this respect, the present revised version of MGS may be potentially useful for monitoring and managing AEs in patients with NHL who received ESHAP±R therapy. The modified MGS was prepared in the form of a clinical pathway and therefore, visually understandable for not only cancer patients but also medical professionals, including pharmacists. Thus, the present modified MGS may enable medical professionals to accomplish secure and timely monitoring of AEs, regardless of the abundance of practical experience.

This study has some limitations. It was carried out in a small number of patients in a single institution, and the data were retrospectively analyzed. A large-scale and multi-institutional study is needed to confirm the accuracy of the revised MGS.

Conclusion

Monitoring of AEs was carried out in adult patients with NHL who received ESHAP±R therapy using MGS. A total of 246 AEs occurred with different onset timings, all of which were predictable AE items. Among those AEs, 149 events (60%) were predicted with respect to the onset and duration using the original MGS. After revision of the onset and duration of some AEs in the MGS, the rate of prediction accuracy increased significantly to 84.2% (95%CI=78.9-88.5%). Therefore, it is concluded that the revised MGS for ESHAP±R therapy is potentially useful for the rapid and accurate monitoring of AEs in patients with NHL.

Acknowledgements

The Authors are grateful to Professor Ryozo Oishi, Professor Emeritus at Kyushu University; Professor Yoshinori Itoh, Professor Emeritus at Gifu University; and Dr. Hiroaki Ikesue at the Department of Pharmacy, Kobe City Medical Center General Hospital for their valuable comments on the manuscript. The Authors also thank Ms. Misui Kashiwagi, Ms. Nami Maegawa, and Ms. Aoi Takano for their technical assistance.

Footnotes

  • Authors’ Contributions

    Mayako Uchida: Conceptualization, Methodology, Formal analysis, Writing- Original draft preparation. Hanae Morikawa, Hiroko Yonemitsu, Kimitaka Suetsugu, Toshikazu Tsuji, Hiroyuki Watanabe: Data collection. Saeko Murata, Takehiro Kawashiri, Koji Kato, Keiko Hosohata, Toshihiro Miyamoto, Nobuaki Egashira: Writing - Review and Editing. Tsutomu Nakamura, Koichi Akashi, Ichiro Ieiri: Writing - Review and Editing, Supervision.

  • Conflicts of Interest

    The Authors declare no conflicts of interest in relation to this study.

  • Funding

    The present study was supported in part by a Grant-in-Aid for Scientific Research (C) from the Japan Society for the Promotion of Science (grant no. 17K08474).

  • Received January 16, 2022.
  • Revision received March 9, 2022.
  • Accepted March 10, 2022.

References

  1. ↵
    1. Fisher RI,
    2. Gaynor ER,
    3. Dahlberg S,
    4. Oken MM,
    5. Grogan TM,
    6. Mize EM,
    7. Glick JH,
    8. Coltman CA Jr. and
    9. Miller TP
    : Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 328(14): 1002-1006, 1993. PMID: 7680764. DOI: 10.1056/NEJM199304083281404
    OpenUrlCrossRefPubMed
    1. Coiffier B,
    2. Lepage E,
    3. Briere J,
    4. Herbrecht R,
    5. Tilly H,
    6. Bouabdallah R,
    7. Morel P,
    8. Van Den Neste E,
    9. Salles G,
    10. Gaulard P,
    11. Reyes F,
    12. Lederlin P and
    13. Gisselbrecht C
    : CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346(4): 235-242, 2002. PMID: 11807147. DOI: 10.1056/NEJMoa011795
    OpenUrlCrossRefPubMed
  3. ↵
    1. Marcus R,
    2. Imrie K,
    3. Belch A,
    4. Cunningham D,
    5. Flores E,
    6. Catalano J,
    7. Solal-Celigny P,
    8. Offner F,
    9. Walewski J,
    10. Raposo J,
    11. Jack A and
    12. Smith P
    : CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood 105(4): 1417-1423, 2005. PMID: 15494430. DOI: 10.1182/blood-2004-08-3175
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Ezzat AA,
    2. Khalifa F,
    3. Berry J,
    4. Khan B,
    5. Raja MA and
    6. Abdel-Warith A
    : E-SHAP: an effective treatment in selected patients with relapsed non-Hodgkin’s lymphoma. Ann Oncol 5(5): 453-456, 1994. PMID: 8075052. DOI: 10.1093/oxfordjournals.annonc.a058879
    OpenUrlCrossRefPubMed
    1. Rodriguez MA,
    2. Cabanillas FC,
    3. Velasquez W,
    4. Hagemeister FB,
    5. McLaughlin P,
    6. Swan F and
    7. Romaguera JE
    : Results of a salvage treatment program for relapsing lymphoma: MINE consolidated with ESHAP. J Clin Oncol 13(7): 1734-1741, 1995. PMID: 7602363. DOI: 10.1200/JCO.1995.13.7.1734
    OpenUrlAbstract/FREE Full Text
    1. Martín A,
    2. Conde E,
    3. Arnan M,
    4. Canales MA,
    5. Deben G,
    6. Sancho JM,
    7. Andreu R,
    8. Salar A,
    9. García-Sanchez P,
    10. Vázquez L,
    11. Nistal S,
    12. Requena MJ,
    13. Donato EM,
    14. González JA,
    15. León A,
    16. Ruiz C,
    17. Grande C,
    18. González-Barca E,
    19. Caballero MD and Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL/TAMO Cooperative Group)
    : R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study. Haematologica 93(12): 1829-1836, 2008. PMID: 18945747. DOI: 10.3324/haematol.13440
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Ueda K,
    2. Nannya Y,
    3. Asai T,
    4. Yamamoto G,
    5. Hangaishi A,
    6. Takahashi T,
    7. Imai T and
    8. Kurokawa M
    : Efficacy and safety of modified rituximab-ESHAP therapy for relapsed/refractory B-cell lymphoma. J Chemother 22(1): 54-57, 2010. PMID: 20227994. DOI: 10.1179/joc.2010.22.1.54
    OpenUrlCrossRefPubMed
  8. ↵
    1. Balducci L and
    2. Carreca I
    : The role of myelopoietic growth factors in managing cancer in the elderly. Drugs 62(Suppl 1): 47-63, 2002. PMID: 12479594. DOI: 10.2165/00003495-200262001-00004
    OpenUrlCrossRefPubMed
    1. Doorduijn J,
    2. Buijt I,
    3. Holt B,
    4. Steijaert M,
    5. Uyl-de Groot C and
    6. Sonneveld P
    : Self-reported quality of life in elderly patients with aggressive non-Hodgkin’s lymphoma treated with CHOP chemotherapy. Eur J Haematol 75(2): 116-123, 2005. PMID: 16000127. DOI: 10.1111/j.1600-0609.2005.00438.x
    OpenUrlCrossRefPubMed
  10. ↵
    1. Balducci L,
    2. Mo M,
    3. Abella E and
    4. Saven A
    : Retrospective analysis of relative dose intensity in patients with non-Hodgkin lymphoma receiving CHOP-based chemotherapy and pegfilgrastim. Am J Clin Oncol 37(6): 603-610, 2014. PMID: 25350463. DOI: 10.1097/COC.0000000000000141
    OpenUrlCrossRefPubMed
  11. ↵
    1. Uchida M,
    2. Nakamura T,
    3. Watanabe H,
    4. Kato K,
    5. Miyamoto T,
    6. Akashi K and
    7. Masuda S
    : Usefulness of medication instruction sheets for sharing information on cancer chemotherapy within the health care team. Pharmazie 74(9): 566-569, 2019. PMID: 31484599. DOI: 10.1691/ph.2019.9467
    OpenUrlCrossRefPubMed
    1. Patel H and
    2. Gurumurthy P
    : Implementation and evaluation of medicine and therapeutic information service by clinical pharmacists in oncology care setting. J Oncol Pharm Pract 25(1): 60-67, 2019. PMID: 28841101. DOI: 10.1177/1078155217727141
    OpenUrlCrossRefPubMed
    1. Boşnak AS,
    2. Birand N,
    3. Diker Ö,
    4. Abdi A and
    5. Başgut B
    : The role of the pharmacist in the multidisciplinary approach to the prevention and resolution of drug-related problems in cancer chemotherapy. J Oncol Pharm Pract 25(6): 1312-1320, 2019. PMID: 29984626. DOI: 10.1177/1078155218786048
    OpenUrlCrossRefPubMed
    1. Fornasier G,
    2. Taborelli M,
    3. Francescon S,
    4. Polesel J,
    5. Aliberti M,
    6. De Paoli P and
    7. Baldo P
    : Targeted therapies and adverse drug reactions in oncology: the role of clinical pharmacist in pharmacovigilance. Int J Clin Pharm 40(4): 795-802, 2018. PMID: 29785683. DOI: 10.1007/s11096-018-0653-5
    OpenUrlCrossRefPubMed
    1. Aziz MT,
    2. Rehman TU,
    3. Qureshi S and
    4. Andleeb S
    : Effects of multidisciplinary teams and an integrated follow-up electronic system on clinical pharmacist interventions in a cancer hospital. Int J Clin Pharm 39(6): 1175-1184, 2017. PMID: 28918483. DOI: 10.1007/s11096-017-0530-7
    OpenUrlCrossRefPubMed
    1. Holle LM,
    2. Harris CS,
    3. Chan A,
    4. Fahrenbruch RJ,
    5. Labdi BA,
    6. Mohs JE,
    7. Norris LB,
    8. Perkins J and
    9. Vela CM
    : Pharmacists’ roles in oncology pharmacy services: Results of a global survey. J Oncol Pharm Pract 23(3): 185-194, 2017. PMID: 26854267. DOI: 10.1177/1078155216629827
    OpenUrlCrossRefPubMed
  17. ↵
    1. Ikesue H,
    2. Ishida M,
    3. Uchida M,
    4. Harada M,
    5. Haro T,
    6. Mishima K,
    7. Itoh Y,
    8. Kotsubo K,
    9. Yoshikawa M and
    10. Oishi R
    : Monitoring for potential adverse drug reactions in patients receiving chemotherapy. Am J Health Syst Pharm 61(22): 2366, 2368-2366, 2369, 2004. PMID: 15581259. DOI: 10.1093/ajhp/61.22.2366
    OpenUrlFREE Full Text
  18. ↵
    1. Velasquez WS,
    2. McLaughlin P,
    3. Tucker S,
    4. Hagemeister FB,
    5. Swan F,
    6. Rodriguez MA,
    7. Romaguera J,
    8. Rubenstein E and
    9. Cabanillas F
    : ESHAP – an effective chemotherapy regimen in refractory and relapsing lymphoma: a 4-year follow-up study. J Clin Oncol 12(6): 1169-1176, 1994. PMID: 8201379. DOI: 10.1200/JCO.1994.12.6.1169
    OpenUrlAbstract/FREE Full Text
  19. ↵
    1. Michot JM,
    2. Mazeron R,
    3. Danu A,
    4. Lazarovici J,
    5. Ghez D,
    6. Antosikova A,
    7. Willekens C,
    8. Chamseddine AN,
    9. Minard V,
    10. Dartigues P,
    11. Bosq J,
    12. Carde P,
    13. Koscielny S,
    14. De Botton S,
    15. Ferme C,
    16. Girinsky T and
    17. Ribrag V
    : Concurrent Etoposide, Steroid, High-dose Ara-C and Platinum chemotherapy with radiation therapy in localised extranodal natural killer (NK)/T-cell lymphoma, nasal type. Eur J Cancer 51(16): 2386-2395, 2015. PMID: 26254810. DOI: 10.1016/j.ejca.2015.07.009
    OpenUrlCrossRefPubMed
  20. ↵
    1. Makieda D,
    2. Hisaeda S,
    3. Kinoshita H,
    4. Uchida M,
    5. Ikesue H,
    6. Mishima K,
    7. Watanabe H,
    8. Sueyasu M,
    9. Miyamoto T,
    10. Egashira N and
    11. Oishi R
    : Investigation of adverse drug reactions in bortezomib therapy for relapsed multiple myeloma. Jpn J Pharm Health Care Sci 36(4): 270-276, 2010.
    OpenUrl
  21. ↵
    1. Carey PJ
    : Drug-induced myelosuppression: diagnosis and management. Drug Saf 26(10): 691-706, 2003. PMID: 12862504. DOI: 10.2165/00002018-200326100-00003
    OpenUrlCrossRefPubMed
  22. ↵
    1. Kaplow R
    : Innovations in antineoplastic therapy. Nurs Clin North Am 40(1): 77-94, 2005. PMID: 15733948. DOI: 10.1016/j.cnur.2004.08.007
    OpenUrlCrossRefPubMed
  23. ↵
    1. Rumsey DR
    : How to determine the confidence interval for a population proportion. Available at: https://www.dummies.com/education/math/statistics/how-to-determine-the-confidence-interval-for-a-population-proportion/ [Last accessed on November 1, 2021]
  24. ↵
    1. Crawford J,
    2. Becker PS,
    3. Armitage JO,
    4. Blayney DW,
    5. Chavez J,
    6. Curtin P,
    7. Dinner S,
    8. Fynan T,
    9. Gojo I,
    10. Griffiths EA,
    11. Hough S,
    12. Kloth DD,
    13. Kuter DJ,
    14. Lyman GH,
    15. Mably M,
    16. Mukherjee S,
    17. Patel S,
    18. Perez LE,
    19. Poust A,
    20. Rampal R,
    21. Roy V,
    22. Rugo HS,
    23. Saad AA,
    24. Schwartzberg LS,
    25. Shayani S,
    26. Talbott M,
    27. Vadhan-Raj S,
    28. Vasu S,
    29. Wadleigh M,
    30. Westervelt P,
    31. Burns JL and
    32. Pluchino L
    : Myeloid growth factors, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 15(12): 1520-1541, 2017. PMID: 29223990. DOI: 10.6004/jnccn.2017.0175
    OpenUrlAbstract/FREE Full Text
  25. ↵
    1. Smith TJ,
    2. Bohlke K,
    3. Lyman GH,
    4. Carson KR,
    5. Crawford J,
    6. Cross SJ,
    7. Goldberg JM,
    8. Khatcheressian JL,
    9. Leighl NB,
    10. Perkins CL,
    11. Somlo G,
    12. Wade JL,
    13. Wozniak AJ,
    14. Armitage JO and American Society of Clinical Oncology
    : Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 33(28): 3199-3212, 2015. PMID: 26169616. DOI: 10.1200/JCO.2015.62.3488
    OpenUrlAbstract/FREE Full Text
  26. ↵
    1. Conlan MG,
    2. Armitage JO,
    3. Bast M and
    4. Weisenburger DD
    : Clinical significance of hematologic parameters in non-Hodgkin’s lymphoma at diagnosis. Cancer 67(5): 1389-1395, 1991. PMID: 1991302. DOI: 10.1002/1097-0142(19910301)67:5<1389::aid-cncr2820670519>3.0.co;2-q
    OpenUrlCrossRefPubMed
  27. ↵
    1. Matasar MJ and
    2. Zelenetz AD
    : Overview of lymphoma diagnosis and management. Radiol Clin North Am 46(2): 175-98, vii, 2008. PMID: 18619375. DOI: 10.1016/j.rcl.2008.03.005
    OpenUrlCrossRefPubMed
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