Top

Supportive Care in Cancer

Published in:

01-08-2011 | Original Article

Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

Authors: Shin Ahn, Yoon-Seon Lee, Yun-Hee Chun, In-Ho Kwon, Won Kim, Kyung Soo Lim, Tae Won Kim, Kyoo-Hyung Lee

Published in: Supportive Care in Cancer | Issue 8/2011

Abstract

Objectives

We intended to determine the predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia (FN).

Methods

From January 1, 2007 to December 31, 2008, 396 episodes of FN in 346 cancer patients were retrospectively analyzed. Clinical and laboratory findings and Multinational Association of Supportive Care in Cancer (MASCC) risk-index score were analyzed and correlated with outcome.

Results

Of the 396 episodes, 73 (18.4%) had serious medical complications including 15 (3.8%) deaths. There was significant difference between unfavorable and favorable outcomes in age, gender, hypotension, tachypnea, duration of fever ≤24 h before admission (44.4% vs. 61.3%), interval of ≤7 days since last chemotherapy (34.2% vs. 16.1%), and duration of neutropenia ≥4 days (34.2% vs. 15.8%; P < 0.05 each), as did C-reactive protein (CRP; 15.0 vs. 7.5 mg dL^-1) and platelet count (66.4 × 10³ vs. 123.7 × 10³ mm^-3;P < 0.001 each). MASCC score was significantly lower in unfavorable outcomes than favorable outcomes (19.0 vs. 24.6, P < 0.001). However, prophylactic antibiotics, treatment with granulocyte colony-stimulating factor (G-CSF), and history of FN were not associated with outcome. On multivariate analysis, MASCC risk-index score (OR 23.2, 95% CI 10.48–51.37), tachypnea (OR 3.61, 95% CI 1.44–9.08), thrombocytopenia (OR 3.41, 95% CI 1.69–6.89), increased CRP (OR 3.23, 95% CI 1.62–6.45), and prolonged neutropenia (OR 2.52, 95% CI 1.21–5.25) were independent predictors of unfavorable outcomes.

Conclusion

MASCC risk-index score <21, tachypnea, thrombocytopenia, increased CRP, and prolonged neutropenia may be strongly associated with poor outcomes in cancer patients with FN.

Viscoli C, Castagnola E (2002) Treatment of febrile neutropenia: what is new? Curr Opin Infect Dis 15:377–382PubMedCrossRef

Bodey GP, Buckley M, Sathe YS, Freireich EJ (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–340PubMed

Neth O, Hann I, Turner MW, Klein NJ (2001) Deficiency of mannose-binding lectin and burden of infection in children with malignancy: a prospective study. Lancet 358:614–618PubMedCrossRef

Klaassen RJ, Goodman TR, Pham B, Doyle JJ (2000) “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol 18:1012–1019PubMed

Ohyashiki K (2004) Monotherapy versus dual therapy based on risk categorization of febrile neutropenic patients. Clin Infect Dis 39(Suppl 1):S56–S58PubMedCrossRef

Talcott JA, Finberg R, Mayer RJ, Goldman L (1988) The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation. Arch Intern Med 148:2561–2568PubMedCrossRef

Talcott JA, Whalen A, Clark J, Rieker PP, Finberg R (1994) Home antibiotic therapy for low-risk cancer patients with fever and neutropenia: a pilot study of 30 patients based on a validated prediction rule. J Clin Oncol 12:107–114PubMed

Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18:3038–3051PubMed

Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751PubMedCrossRef

10.

Glasmacher A, von Lilienfeld-Toal M, Schulte S, Hahn C, Schmidt-Wolf IG, Prentice A (2005) An evidence-based evaluation of important aspects of empirical antibiotic therapy in febrile neutropenic patients. Clin Microbiol Infect 11(Suppl 5):17–23PubMedCrossRef

11.

Baskaran ND, Gan GG, Adeeba K, Sam IC (2007) Bacteremia in patients with febrile neutropenia after chemotherapy at a university medical center in Malaysia. Int J Infect Dis 11:513–517PubMedCrossRef

12.

Innes H, Lim SL, Hall A, Chan SY, Bhalla N, Marshall E (2008) Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support Care Cancer 16:485–491PubMedCrossRef

13.

Klastersky J, Ameye L, Maertens J, Georgala A, Muanza F, Aoun M, Ferrant A, Rapoport B, Rolston K, Paesmans M (2007) Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 30(Suppl 1):S51–S59PubMedCrossRef

14.

Uys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer 12:555–560PubMedCrossRef

15.

Uys A, Rapoport BL, Fickl H, Meyer PW, Anderson R (2007) Prediction of outcome in cancer patients with febrile neutropenia: comparison of the Multinational Association of Supportive Care in Cancer risk-index score with procalcitonin, C-reactive protein, serum amyloid A, and interleukins-1beta, -6, -8 and -10. Eur J Cancer Care (Engl) 16:475–483CrossRef

16.

Baskaran ND, Gan GG, Adeeba K (2008) Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 87:563–569PubMedCrossRef

17.

Santolaya ME, Alvarez AM, Becker A, Cofre J, Enriquez N, O'Ryan M, Paya E, Pilorget J, Salgado C, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2001) Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol 19:3415–3421PubMed

18.

Santolaya ME, Alvarez AM, Aviles CL, Becker A, King A, Mosso C, O'Ryan M, Paya E, Salgado C, Silva P, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T, Zubieta M (2008) Predictors of severe sepsis not clinically apparent during the first twenty-four hours of hospitalization in children with cancer, neutropenia, and fever: a prospective, multicenter trial. Pediatr Infect Dis J 27:538–543PubMedCrossRef

19.

Arber C, Passweg JR, Fluckiger U, Pless M, Gregor M, Tichelli A, Schifferli JA, Gratwohl A (2000) C-reactive protein and fever in neutropenic patients. Scand J Infect Dis 32:515–520PubMedCrossRef

20.

Hamalainen S, Kuittinen T, Matinlauri I, Nousiainen T, Koivula I, Jantunen E (2008) Severe sepsis in autologous stem cell transplant recipients: microbiological aetiology, risk factors and outcome. Scand J Infect Dis 41:14–20CrossRef

21.

Engel A, Mack E, Kern P, Kern WV (1998) An analysis of interleukin-8, interleukin-6 and C-reactive protein serum concentrations to predict fever, gram-negative bacteremia and complicated infection in neutropenic cancer patients. Infection 26:213–221PubMedCrossRef

22.

Lehrnbecher T, Venzon D, de Haas M, Chanock SJ, Kuhl J (1999) Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis 29:414–419PubMedCrossRef

23.

Diepold M, Noellke P, Duffner U, Kontny U, Berner R (2008) Performance of Interleukin-6 and Interleukin-8 serum levels in pediatric oncology patients with neutropenia and fever for the assessment of low-risk BMC. Infect Dis 8:28

24.

von Lilienfeld-Toal M, Schneider A, Orlopp K, Hahn-Ast C, Glasmacher A, Stuber F (2006) Change of procalcitonin predicts clinical outcome of febrile episodes in patients with hematological malignancies. Support Care Cancer 14:1241–1245CrossRef

25.

Reuter S, Kern WV, Sigge A, Dohner H, Marre R, Kern P, von Baum H (2005) Impact of fluoroquinolone prophylaxis on reduced infection-related mortality among patients with neutropenia and hematologic malignancies. Clin Infect Dis 40:1087–1093PubMedCrossRef

26.

Kern WV, Klose K, Jellen-Ritter AS, Oethinger M, Bohnert J, Kern P, Reuter S, von Baum H, Marre R (2005) Fluoroquinolone resistance of Escherichia coli at a cancer center: epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia. Eur J Clin Microbiol Infect Dis 24:111–118PubMedCrossRef

27.

Gafter-Gvili A, Fraser A, Paul M, Leibovici L (2005) Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 142:979–995PubMed

28.

Segal BH, Freifeld AG, Baden LR, Brown AE, Casper C, Dubberke E, Gelfand M, Greene JN, Ison MG, Ito JI, Karp JE, Kaul DR, King E, Mackler E, Marcucci G, Montoya JG, Engemann AM, Rolston K, The AS (2008) Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw 6:122–174PubMed

29.

Pizzo PA (1993) Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323–1332PubMedCrossRef

30.

Hartmann LC, Tschetter LK, Habermann TM, Ebbert LP, Johnson PS, Mailliard JA, Levitt R, Suman VJ, Witzig TE, Wieand HS, Miller LL, Moertel CG (1997) Granulocyte colony-stimulating factor in severe chemotherapy-induced afebrile neutropenia. N Engl J Med 336:1776–1780PubMedCrossRef

31.

Ravaud A, Chevreau C, Cany L, Houyau P, Dohollou N, Roche H, Soubeyran P, Bonichon F, Mihura J, Eghbali H, Tabah I, Bui BN (1998) Granulocyte-macrophage colony-stimulating factor in patients with neutropenic fever is potent after low-risk but not after high-risk neutropenic chemotherapy regimens: results of a randomized phase III trial. J Clin Oncol 16:2930–2936PubMed

32.

Vellenga E, Uyl-de Groot CA, de Wit R, Keizer HJ, Lowenberg B, ten Haaft MA, de Witte TJ, Verhagen CA, Stoter GJ, Rutten FF, Mulder NH, Smid WM, de Vries EG (1996) Randomized placebo-controlled trial of granulocyte-macrophage colony-stimulating factor in patients with chemotherapy-related febrile neutropenia. J Clin Oncol 14:619–627PubMed

Title: Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia
Authors: Shin Ahn
Yoon-Seon Lee
Yun-Hee Chun
In-Ho Kwon
Won Kim
Kyung Soo Lim
Tae Won Kim
Kyoo-Hyung Lee
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 8/2011
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-010-0928-4

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2011

Current microbiology of percutaneous endoscopic gastrostomy tube (PEG tube) insertion site infections in patients with cancer

Palonosetron in combination with 1-day versus 3-day dexamethasone for prevention of nausea and vomiting following moderately emetogenic chemotherapy: a randomized, multicenter, phase III trial

Enhancing decision making about participation in cancer clinical trials: development of a question prompt list

Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care

Decisions for lung cancer chemotherapy: the influence of physician and patient factors

Erratum to: When the treatment goal is not cure: are patients informed adequately?

Keynote webinar | Spotlight on antibody–drug conjugates in cancer