BMC Cancer Research article Inflammatory (B) symptoms are independent predictors of myelosuppression from chemotherapy in Non-Hodgkin Lymphoma (NHL) patients – analysis of data from a British National Lymphoma Investigation phase III trial comparing CHOP to PMitCEBO Rohini Sharma1, David Cunningham2, Paul Smith3, Graham Robertson4, Owen Dent4 and Stephen J Clarke*4 BioMed Central Open Access Address: 1Imperial College, London, UK, 2Royal Marsden Hospital, Sutton, Surrey, UK, 3Lymphoma Trials Office, Cancer Research UK & UCL Cancer Trials Centre, 90 Tottenham Court Road, London, UK and 4The University of Sydney, Department of Medicine, Concord Hospital, Concord, NSW, Australia Email: Rohini Sharma - r.sharma@imperial.ac.uk; David Cunningham - David.Cunningham@rmh.nhs.uk; Paul Smith - p.smith@ctc.ucl.ac.uk; Graham Robertson - grobertson@med.usyd.edu.au; Owen Dent - owen.dent@netspeed.com.au; Stephen J Clarke* - sclarke@med.usyd.edu.au * Corresponding author Published: 18 May 2009 BMC Cancer 2009, 9:153 doi:10.1186/1471-2407-9-153 This article is available from: http://www.biomedcentral.com/1471-2407/9/153 Received: 30 October 2008 Accepted: 18 May 2009 © 2009 Sharma et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Toxicity from chemotherapy is highly variable, unpredictable and results in substantial morbidity and increased healthcare costs. New predictors of toxicity are required to improve the safety and efficacy of chemotherapy. Inflammatory or B symptoms in lymphoma are associated with elevated plasma inflammatory markers and predict worse treatment response and survival. Recent data suggest that systemic inflammation results in reduced hepatic drug metabolism and increased toxicity from chemotherapy. We investigated whether B symptoms were associated with greater toxicity in patients treated for non-Hodgkin lymphoma (NHL). Methods: The British National Lymphoma Investigation compared two chemotherapy regimens in older patients with aggressive NHL. Approximately 50% of patients had B symptoms. Demographic and toxicity data on 664 patients were analysed to identify predictors of toxicity by multivariate analysis, with particular reference to B symptoms. Results: Using univariate analyses, severe (grades 3–4) leucopenia, anaemia, thrombocytopenia, nausea and vomiting and diarrhoea occurred more frequently in patients with B symptoms. The associations between B symptoms and severe leucopenia (OR 1.7, p = 0.005) and anaemia (OR 2.3, p = 0.025) persisted after adjustment for other prognostic factors in multivariate analyses. The use of granulocyte colony stimulating factor reduced neutropenia in patients with both A and B symptoms. Conclusion: For the first time and in a large NHL cohort we have shown that inflammatory symptoms are independent predictors for myelosuppression from chemotherapy. These data will enable improved prognostication for toxicity and provide individualisation of therapy in NHL and other tumours. These findings also create the potential for strategies used prior to chemotherapy aimed at reducing systemic inflammation in order to improve drug metabolism and reduce treatment-related toxicity. Trial registration number: ISRCTN98741793 Page 1 of 10 (page number not for citation purposes)