P034 | SAFETY USE OF DOXORUBICIN-CONTAINING REGIMENS WITHOUT HEMOLYTIC COMPLICATIONS IN G6PD DEFICIENT PATIENTS AFFECTED BY LARGE B-CELL LYMPHOMAS

Glucose 6-phosphate dehydrogenase deficiency (G6PD-) is one of the most common human enzyme defects, mainly found in malaria-endemic areas. There are conflicting reports linking G6PD- oxidative hemolysis and doxorubicin administration; thus, the safe use of doxorubicin in G6PD- patients is still controversial. To date, there is no globally recognized approach to the management of G6PD- lymphoma patients: some physicians omit doxorubicin from the chemotherapy regimen, others replace it with etoposide, negatively affecting the efficacy of the treatment. To our best knowledge, only a few case reports on the subject have been published and only one study was conducted. In this retrospective single-center analysis we aimed to evaluate hemolytic complications in G6PD- patients receiving doxorubicin containing regimens. Secondary endpoints were overall survival (OS) and event-free survival (EFS). We evaluated a sample of 109 Italian adult G6PD- patients with newly-diagnosed DLBCL (85,3%), other Large B-cell Lymphomas (13,8%) and Primary Effusion Lymphoma (0,9%), referred to our center between 1993 to 2024. Clinical data were obtained retrospectively from medical records. All patients were treated in first-line with RCHOP/CHOP-like regimens, DA-EPOCH-R, R-CODOX-M/R-IVAC or (V)ACOPB±R. For each patient, hemoglobin (Hb), total and indirect bilirubin, reticulocytes and LDH values ​​were evaluated at baseline and after each cycle of therapy, for a total of 561 doxorubicin infusions analyzed; haptoglobin and reticulocytes were measured only in cases in which hemolysis was suspected. We considered significant a decrease in Hb ≥ 2 g/dL from baseline up to 3 weeks after each doxorubicin infusion. In addition, we considered potential anemia-related factors: β-thalassemic trait, deficiency anemias, bone marrow localization. At baseline, Direct Coombs Test (DCT) resulted positive in 13 out of 70 evaluated patients. Among our population, the 33% of patients who suffered a significant Hb decrease didn’t show any sign of hemolysis. Out of the 109 patients analyzed, only one showed a persistent increase of the hemolysis index, compatible with the preexistent diagnosis of lymphoma-related cryoagglutinin hemolytic anemia. In the most representative population of LBCL OS and PFS rates were in line with literature results. Our data suggest that doxorubicin can be safely used in G6PD-deficient patients, with apparently no risk of hemolytic anemia.