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Supportive Care in Cancer
Published in: Supportive Care in Cancer 10/2016

01-10-2016 | Original Article

Relationship between severity and duration of chemotherapy-induced neutropenia and risk of infection among patients with nonmyeloid malignancies

Authors: Yanli Li, Zandra Klippel, Xiaolong Shih, Maureen Reiner, Hong Wang, John H. Page

Published in: Supportive Care in Cancer | Issue 10/2016

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Abstract

Purpose

Chemotherapy-induced neutropenia (CIN) may increase infection risk for cancer patients; however, there is limited understanding on the quantitative relationships between severity and duration of CIN and infection risk.

Methods

This study combined individual data from adult cancer patients receiving no granulocyte colony-stimulating factor during the first chemotherapy cycle in six trials. We used area over the curve (AOC) of absolute neutrophil count (ANC) time-response curve (below different thresholds) to measure the combined effect of severity and duration of CIN. Time-dependent Cox proportional hazards models quantified the hazard of first infection associated with duration of grade 4 or grade 3/4 CIN and the hazard associated with AOC.

Results

We analyzed data from 271 patients who had small cell lung cancer, non-Hodgkin’s lymphoma, head and neck cancer, or breast cancer; 63.8 % of the patients had advanced cancer, and 77.5 % received chemotherapy regimens with high risk of febrile neutropenia. In the first cycle, 18.8 % of the patients had infection-related hospitalizations. Each additional day patients had grade 3/4 or grade 4 CIN was associated with 28 % (95 % CI 7, 51 %) and 30 % (95 % CI 10, 54 %) increased risk of infection-related hospitalization, respectively. Each unit increase in AOC (day × 109/L ANC), with threshold of ANC < 0.5 × 109/L, was associated with a significantly increased risk of infection-related hospitalization (hazard ratio 1.98; 95 % CI 1.35, 2.90).

Conclusions

Infection risk increases dramatically with each additional day of grade 3 or 4 CIN. Interventions limiting CIN severity and duration are of critical importance to reduce infection risk in cancer patients receiving chemotherapy.
Appendix
Available only for authorised users
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Metadata
Title
Relationship between severity and duration of chemotherapy-induced neutropenia and risk of infection among patients with nonmyeloid malignancies
Authors
Yanli Li
Zandra Klippel
Xiaolong Shih
Maureen Reiner
Hong Wang
John H. Page
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 10/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3277-0

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