Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Jul;27(7):2413-2424.
doi: 10.1007/s00520-019-04773-6. Epub 2019 Apr 16.

Patient factors and their impact on neutropenic events: a systematic review and meta-analysis

Pinkie Chambers  1 , Yogini Jani  2 , Li Wei  3 , Emma Kipps  4 , Martin D Forster  5 , Ian C K Wong  3   6
Affiliations
Meta-Analysis

Patient factors and their impact on neutropenic events: a systematic review and meta-analysis

Pinkie Chambers et al. Support Care Cancer. 2019 Jul.

Abstract

Background: Neutropenia is associated with an increased risk of mortality and hospitalisation. Strategies, including the prescribing of colony-stimulating growth factors (CSFs), are adopted when a high risk (> 20%) of neutropenic complications are seen in the clinical trial setting. With a diverse treatment population that may differ from the patient groups recruited to studies, appropriate prescribing decisions by clinicians are essential. At present, results are conflicting from studies evaluating the risks of certain patient attributes on neutropenic events; we aimed to aggregate these associations to guide future management.

Design: A systematic review with a meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Studies were identified through a literature search using MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from inception to December 1, 2017. Studies were included into a meta-analysis if they adjusted for confounders; analyses were conducted in STATA v 15.1 SE.

Results: A total of 4415 articles were retrieved by the search with 37 meeting the inclusion criteria and 12 eligible for meta-analysis. Meta-analysis was conducted for increasing age and yielded a pooled odds ratio of 1.39 (1.11, 1.76, I2 = 24.1%), in our subgroup analysis of 4814 patients. Odds ratios for studies were pooled that reported associations for one co-morbidity compared to none and resulted in an overall odds of 1.54 (CI 1.09-2.09, I2 = 13.1%), including 9189 patients in total.

Conclusions: Results can enhance current guidance in prescribing primary prophylaxis for treatments that either fall marginally under the internationally recognised 20% neutropenia risk.

Keywords: Cancer; Chemotherapy; Neutropenia; Neutropenic sepsis; Risk.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Meta-analysis showing pooled odds of neutropenic events with ages > 65 years. OR, odds ratios; CI, confidence intervals
Fig. 3
Fig. 3
Subgroup analysis showing pooled odds of neutropenic events with > 65 years. Only studies adjusting for confounders included. OR, odds ratios; CI, confidence intervals
Fig. 4
Fig. 4
Meta-analysis showing pooled odds of neutropenic events with one co-morbidity compared to zero. OR, odds ratios; CI, confidence intervals
See this image and copyright information in PMC

References

    1. Lyman GH, Kuderer NM, Djulbegovic B. Prophylactic granulocyte colony-stimulating factor in patients receiving dose-intensive cancer chemotherapy: a meta-analysis. Am J Med. 2002;112:406–411. doi: 10.1016/S0002-9343(02)01036-7. - DOI - PubMed
    1. Smith TJ, Bohlke K, Lyman GH, Carson KR, Crawford J, Cross SJ, Goldberg JM, Khatcheressian JL, Leighl NB, Perkins CL, Somlo G, Wade JL, Wozniak AJ, Armitage JO, American Society of Clinical Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2015;33:3199–3212. doi: 10.1200/JCO.2015.62.3488. - DOI - PubMed
    1. Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, Herrstedt J, Committee EG. Management of febrile neutropaenia: ESMO clinical practice guidelines. Ann Oncol. 2016;27:v111–v118. doi: 10.1093/annonc/mdw325. - DOI - PubMed
    1. Smith TJ, Hillner BE. Real-world conundrums and biases in the use of white cell growth factors. Am Soc Clin Oncol Educ Book. 2016;35:e524–e527. doi: 10.1200/EDBK_156062. - DOI - PubMed
    1. Khoja L, Atenafu EG, Ye Q, Gedye C, Chappell M, Hogg D, Butler MO, Joshua AM. Real-world efficacy, toxicity and clinical management of ipilimumab treatment in metastatic melanoma. Oncol Lett. 2016;11:1581–1585. doi: 10.3892/ol.2015.4069. - DOI - PMC - PubMed

LinkOut - more resources