{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:36Z","timestamp":1787030736091,"version":"build-2736575974"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite prophylactic interventions, chemotherapy-related myelosuppression remains an important clinical concern in patients with diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP. This study characterized its occurrence patterns, baseline predictors, temporal risk, and dynamic heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We established an 8-year longitudinal cohort of patients with DLBCL who received standard-dose R-CHOP between 2016 and 2024. Endpoints included WHO-defined grade \u22651 and grade \u22653 myelosuppression and severe lineage-specific complications. Correlation analyses evaluated associations between baseline laboratory parameters and HGB-, NEUT-, PLT-, and WBC-related suppression. Multiple machine-learning models were developed for each endpoint and hematologic dimension. L2-regularized Cox proportional hazards models were used for time-to-event analyses, with supplementary time-dependent Cox analyses evaluating G-CSF exposure for NEUT-related endpoints. K-means clustering of longitudinal hematologic features was performed to identify dynamic subphenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 262 patients, advanced Lugano stage and the high-risk IPI subgroup were associated with several severe myelosuppression outcomes, while sex, infection status, and functional or anthropometric characteristics showed endpoint-specific associations. HCT, HGB, and RBC were negatively associated with HGB- and PLT-related myelosuppression and grade \u22653 NEUT-related myelosuppression, whereas RDW-CV and RDW-SD were positively associated with several severe outcomes. Models for HGB- and PLT-related endpoints achieved AUCs &amp;gt;0.80 for grade \u22651, grade \u22653, and corresponding severe-complication outcomes, whereas NEUT-related models showed lower discrimination. Baseline HCT was independently associated with lower hazards of grade \u22651 HGB-related myelosuppression (HR\u202f=\u202f0.918, 95% CI 0.894\u20130.943), grade \u22653 HGB-related myelosuppression (HR\u202f=\u202f0.910, 95% CI 0.882\u20130.940), and severe anemia (HR\u202f=\u202f0.934, 95% CI 0.902\u20130.966). RDW-CV independently increased the hazards of grade \u22651 and grade \u22653 PLT-related myelosuppression, while baseline NEUT# reduced the hazard of grade \u22651 NEUT-related myelosuppression (HR\u202f=\u202f0.835, 95% CI 0.760\u20130.918; FDR-adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0026). G-CSF exposure was not significantly associated with NEUT-related endpoints after endpoint-level FDR correction. Clustering identified a high-severity, high-variability subtype and a comparatively mild, stable subtype; recovery patterns differed across hematologic dimensions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>R-CHOP-related myelosuppression is heterogeneous in occurrence, temporal evolution, and recovery. Baseline clinical and laboratory features may support early risk stratification, dynamic monitoring, and individualized supportive care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1839446","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:17Z","timestamp":1787027357000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early identification of high-risk myelosuppression subtypes in DLBCL patients undergoing R-CHOP chemotherapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Keyi","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]},{"name":"Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianming","family":"Du","sequence":"additional","affiliation":[{"name":"College of Medicine and Biological Information Engineering, Northeastern University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoxin","family":"Liu","sequence":"additional","affiliation":[{"name":"The 967th Hospital of PLA Joint Logistics Support Force","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[{"name":"College of Medicine and Biological Information Engineering, Northeastern University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Xing\u2019an League People\u2019s Hospital of Inner Mongolia","place":["Inner Mongolia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Fourth Affiliated Hospital of China Medical University","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqiang","family":"Ma","sequence":"additional","affiliation":[{"name":"The 967th Hospital of PLA Joint Logistics Support Force","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanli","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Central Hospital of Dalian University of Technology","place":["Dalian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangjun","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.3322\/caac.21357","article-title":"2016 US lymphoid malignancy statistics by World Health Organization subtypes","volume":"66","author":"Teras","year":"2016","journal-title":"CA Cancer J 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