L-2124. Early Discharge of Patients (pts) with Febrile Neutropenia (FN) Orally Treated and Assessed at Low Risk (LR) for Medical Complications Using the MASCC Score - Data from a Multicenter Therapeutic Trial (46001)
Session: Poster Session: Management of Infections in the Immunocompromised Hosts
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: A substantial rate of pts with FN is treated orally in an outpt setting. The MASCC score has been recommended for identifying pts with FN at LR but there is no data from multicenter trials validating the MASCC LR prediction rule in outpts or pts discharged early Methods: We performed a double-blind, randomized, international trial comparing the efficacy/safety of oral moxifloxacin versus ciprofloxacin/augmentin in pts with FN, a MASCC score >20 (LR), able to swallow. It was intended to discharge pts as soon as possible based on predefined medical and non-medical criteria Results: Of the 333 eligible pts, 50% had solid tumor and 69% were outpts at fever onset; 244 pts were eligible for early discharge (ie before the end of atb therapy) and 195 (59%; 95%CI, 53-64%) were eventually discharged early, with similar rates of pts in the two arms over time : 26% within 6 h, 34% at 24 h, 39% at 48 h. There was no death and readmission because of clinical deterioration or complication was required in only 9 pts leading to a 5% serious adverse events (SAE) rate (95%CI, 2-9%); 49 pts (15%; 95%CI, 11-19%) were eligible but not discharged for a variety of reasons while 89 pts (27%; 95%CI, 22%-32%) were not eligible for discharge (many due to psychosocial reasons). The number of pts with SAE among those not discharged was 9 (7%; 95%CI, 3-12%). Conclusions: Most pts with FN predicted at LR by the MASCC score, orally treated can be safely discharged early. This international study confirms that, in the outpt setting, these pts remain at LR for serious complications leading to readmission (<10%)
for the EORTC IDG, Claudio Viscoli, MD, San Martino Hospital, Genova, Italy, Hamdi Akan, University Hospital, Johan Maertens, MD, University Hospital Gastuisberg, Leuven, Belgium, Lubos Drgona, NCI, Marianne Paesmans, EORTC, Mickael Aoun, Inst Bordet, Murat Akova, Hacett. Hosp., Oscar Marchetti, CHUV, Robrecht De Bock, AZ Midd., Thierry Calandra, MD, PhD, CHUV, Lausanne, AB, Switzerland, Winfried Kern, University Hospital, Freiburg, Germany and  W. V. Kern, None.

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