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. 2011 Aug 23;105(5):612-7.
doi: 10.1038/bjc.2011.284. Epub 2011 Aug 2.

Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients

A Carmona-Bayonas  1 , J Gómez, E González-Billalabeitia, M Canteras, A Navarrete, M L Gonzálvez, V Vicente, F Ayala de la Peña
Affiliations

Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients

A Carmona-Bayonas et al. Br J Cancer. .

Abstract

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Background: Predictive models to identify low-risk febrile neutropenia (FN) have been developed with heterogeneous samples, which included stable and unstable patients, solid tumours, acute leukaemia and bone marrow transplantation. These models fail to recognise 5-15% of cases with unexpected complications, and literature specifically addressing apparently stable patients (ASPs) is scarce.

Methods: We reviewed 861 episodes of FN in outpatients with solid tumours, including 692 (80%) episodes with apparent clinical stability. We aimed to investigate the prognosis of this latter group and explore the possibility of stratifying it according to the presenting features. A case-control study was performed and the MASCC index was evaluated.

Results: The rates of complications and bacteraemia in ASPs were 7.3% and 6.2%, respectively. The MASCC index yielded a low sensitivity to detect complications (36%). Prognostic factors were identified: ECOG performance status ≥2, chronic bronchitis, chronic heart failure, stomatitis NCI grade ≥2, monocytes <200 mm(-3) and stress hyperglycaemia.

Conclusion: A very simple assessment is useful to classify the patients with FN according to the risk of complications. A few additional variables may predict the clinical course of the patients. We additionally show that the MASCC index applied to this specific group has a low sensitivity to predict complications.

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Figure 1
Figure 1
Flowchart summarising the study design.
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