Febrile neutropenia in adults with diffuse large B-cell lymphoma receiving first-line R-CHOP-based therapy: a systematic review and meta-analysis of observational and trial evidence

Febrile neutropenia (FN) is an important complication of first-line immunochemotherapy for diffuse large B-cell lymphoma (DLBCL). Thresholds for primary granulocyte colony-stimulating factor (G-CSF) prophylaxis are risk-based, but the FN burden in routine practice is uncertain, and whether trial-derived estimates describe it is unknown.

Systematic review and meta-analysis of proportions. MEDLINE, CENTRAL, ClinicalTrials.gov, Europe PMC, Epistemonikos, Lens.org, Google Scholar, and citation tracking were searched from inception to 8 September 2026. Eligible studies reported FN incidence in adults with DLBCL receiving first-line R-CHOP or R-CHOP-like therapy. Analyses were stratified by design, because observational cohorts and trials measure FN under materially different conditions. Risk of bias and certainty were assessed using ROBINS-I/RoB 2 and GRADE.