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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -26 مورد

Factors to consider in assessing risk of an episode of neutropenic fever in patients undergoing cytotoxic chemotherapy for malignancy

Factors to consider in assessing risk of an episode of neutropenic fever in patients undergoing cytotoxic chemotherapy for malignancy
Factors related to Factor Effect on risk
Patient characteristics
  • Advanced age
  • Risk increases if age ≥65 years[1]
  • Performance status
  • Risk increases if ECOG performance score ≥2[1]
  • Nutritional status
  • Risk increases if albumin <35 g/L[2,3]
  • Prior neutropenic fever episode
  • Risk in cycles 2 to 6 is fourfold greater if neutropenic fever episode occurs in cycle 1[4]
  • Comorbidities
  • Neutropenic fever odds increase by 27, 67, and 125% for one, two, or three or more comorbidities, respectively[1,5]
Underlying malignancy
  • Cancer diagnosis
 Diagnosis Reported neutropenic fever rates (%)
  • Acute leukemia/MDS
 85.0 to 95.0[6-9]
  • High-grade lymphoma
 35.0 to 71.0*[10]
  • Soft tissue sarcoma
 27.0 (95% CI 19.0-34.5)[4,5,11,12]
  • NHL/myeloma
 26.0 (95% CI 22.0-29.0)[4,5,11,12]
  • Germ cell carcinoma
 23.0 (95% CI 16.6-29.0)[4,5,11,12]
  • Hodgkin lymphoma
 15.0 (95% CI 6.6-24.0)[4,5,11,12]
  • Ovarian carcinoma
 12.0 (95% CI 6.6-17.7)[4,5,11,12]
  • Lung cancers
 10.0 (95% CI 9.8-10.7)[4,5,11,12]
  • Colorectal cancers
 5.5 (95% CI 5.1-5.8)[4,5,11,12]
  • Head and neck carcinoma
 4.6 (95% CI 1.0-8.2)[4,5,11,12]
  • Breast cancer
 4.4 (95% CI 4.1-4.7)[4,5,11,12]
  • Prostate cancer
 1.0 (95% CI 0.9-1.1)[4,5,11,12]
  • Cancer stage
  • Risk increases for advanced stage (≥2)[4]
  • Remission status
  • Risk increases if not in remission[8,13]
  • Cancer treatment response
  • Risk is lowest if patient has a CR
  • If patient has a PR, neutropenic fever risk is greater for acute leukemia than for solid tissue malignancies[8]
  • Neutropenic fever risk is higher in patients with persistent, refractory, or progressive disease despite treatment[14,15]
Treatment of malignancy
  • Cytotoxic regimen
 Risk is higher with regimens that include:
  • Anthracyclines at doses ≥90 mg/m2
  • Cisplatin at doses ≥100 mg/m2
  • Ifosfamide at doses ≥9 g/m2
  • Cyclophosphamide at doses ≥1 g/m2
  • Etoposide at doses ≥500 mg/m2
  • Cytarabine at doses ≥1 g/m2
  • High dose density
  • Anthracycline + taxane, and cyclophosphamide or gemcitabine, for breast cancer
  • Dose intensity
  • Increased risk if >85% of scheduled doses are administered[12,16]
  • Degree and duration of GI and/or oral mucositis
  • Risk is greatest if NCI mucositis grade is ≥3 (GI) or if peak score on OMAS is ≥2[9,17,18]
  • Degree and duration of cytopenia
  • Profound, protracted neutropenia
 ANC <100/mcL for ≥7 days[19-21]
  • Lymphopenia
 ALC <700/mcL (ANC surrogate)[11,22]
  • Monocytopenia
 AMC <150/mcL (ANC surrogate)[23]

ALC: absolute lymphocyte count; AMC: absolute monocyte count; ANC: absolute neutrophil count; CR: complete response; ECOG: Eastern Cooperative Oncology Group; GI: gastrointestinal; MDS: myelodysplastic syndrome; NCI: National Cancer Institute; NHL: non-Hodgkin lymphoma; OMAS: oral mucositis assessment scale; PR: partial response.

* Grade 3 and 4 neutropenia. Treatment included colony-stimulating factors and antimicrobial prophylaxis. Rate of neutropenia varied by chemotherapy regimen.
References:
  1. Lyman GH, Abella E, Pettengell R. Risk factors for febrile neutropenia among patients with cancer receiving chemotherapy: A systematic review. Crit Rev Oncol Hematol 2014; 90:190.
  2. Lyman GH, Dale DC, Friedberg J, et al. Incidence and predictors of low chemotherapy dose intensity in aggressive non-Hodgkin's lymphoma: A nationwide study. J Clin Oncol 2004; 22:4302.
  3. Intragumtornchai T, Sutheesophon J, Sutcharitchan P, et al. A predictive model for life threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin's lymphoma. Leuk Lymphoma 2000; 37:351.
  4. Cullen MH, Billingham LJ, Gaunt CH, et al. Rational selection of patients for antibacterial prophylaxis after chemotherapy. J Clin Oncol 2007; 25:4821.
  5. Hosmer W, Malin J, Wong M. Development and validation of a prediction model for the risk of developing febrile neutropenia in the first cycle of chemotherapy among elderly patients with breast, lung, colorectal, and prostate cancer. Support Care Cancer 2011; 19:333.
  6. Bow EJ. Infectious complications in patients receiving cytotoxic therapy for acute leukemia: History, background, and approaches to management. In: Management of Infection in Oncology Patients, Wingard JR, Bowden RA (Eds), Martin Dunitz, London 2003. p 71.
  7. Gardner A, Mattiuzzi G, Faderl S, et al. Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. J Clin Oncol 2008; 26:5684.
  8. Klastersky J, Paesmans M, Rubenstein EB, et al. 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 2000; 18:3038.
  9. Bow EJ, Meddings JB. Intestinal mucosal dysfunction and infection during remission-induction therapy for acute myeloid leukaemia. Leukemia 2006; 20:2087.
  10. Romaguera JE, Fayad L, Rodriguez MA, et al. High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol 2005; 23:7013.
  11. Ray-Coquard I, Borg C, Bachelot T, et al. Baseline and early lymphopenia predict for the risk of febrile neutropenia after chemotherapy. Br J Cancer 2003; 88:181.
  12. Pettengell R, Schwenkglenks M, Leonard R, et al. Neutropenia occurrence and predictors of reduced chemotherapy delivery: Results from the INCEU prospective observational European neutropenia study. Support Care Cancer 2008; 16:1299.
  13. Talcott JA, Finberg R, Mayer RJ, et al. The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation. Arch Intern Med 1988; 148:2561.
  14. Bow EJ, Kilpatrick MG, Scott BA, et al. Acute myeloid leukemia inManitoba. The consequences of standard "7 + 3" remission-induction therapy followed by high dose cytarabine postremission consolidation for myelosuppression, infectious morbidity, and outcome. Cancer 1994; 74:52.
  15. Talcott JA, Siegel RD, Finberg R, et al. Risk assessment in cancer patients with fever and neutropenia: A prospective, two-center validation of a prediction rule. J Clin Oncol 1992; 10:316.
  16. Schwenkglenks M, Jackisch C, Constenla M, et al. Neutropenic event risk and impaired chemotherapy delivery in six European audits of breast cancer treatment. Support Care Cancer 2006; 14:901.
  17. Sonis ST, Oster G, Fuchs H, et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 2001; 19:2201.
  18. Bodey GP, Buckley M, Sathe YS, et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328.
  19. Blay JY, Chauvin F, Le Cesne A, et al. Early lymphopenia after cytotoxic chemotherapy as a risk factor for febrile neutropenia. J Clin Oncol 1996; 14:636.
  20. Bodey GP, Rodriguez V, Chang HY, et al. Fever and infection in leukemic patients: A study of 494 consecutive patients. Cancer 1978; 41:1610.
  21. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730.
  22. Oguz A, Karadeniz C, Ckitak EC, et al. Which one is a risk factor for chemotherapy-induced febrile neutropenia in childhood solid tumors: Early lymphopenia or monocytopenia? Pediatr Hematol Oncol 2006; 23:143.
  23. Aapro MS, Cameron DA, Pettengell R, et al. EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 2006; 42:2433.

Reproduced with permission from: Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA Clinical Practice Guideline update. J Clin Oncol 2018; 36(30):3043-3054. Copyright © 2018 American Society of Clinical Oncology. https://ascopubs.org/journal/jco.

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