Background: Prediction of febrile neutropenia (FN) with initiation of preventive measures in high-risk populations may lead to better outcomes in cancer treatment. We have previously developed a score to predict FN in the first cycle of chemotherapy*. We aimed to develop and validate a cycle-specific score to predict FN in cycles two to six as guidelines recommend assessing the risk of FN at each cycle start.
Methods: We included consecutive patients with solid cancers at Rigshospitalet, University of Copenhagen, 2010-2016. FN was defined as neutrophils < 0.5x109/L or leukocytes ≤ 2.0x109/L at the time of either a blood culture sample or death. Predictors of FN were analysed using Poisson regression adjusted for repeated measurements using 2:1 random split-sampling. Risk factors assessed were: FENCE risk groups*, sex, body surface area, Charlson Comorbidity Index score, haemoglobin, leukocyte and platelet levels, chemotherapy drugs, radiotherapy, prophylactic granulocyte colony-stimulating factors (G-CSF), previous FN or neutropenia, dose delays, dose reductions, and cycle number. Parameter estimates were scaled and summed to create the risk score.
Results: There were 324 FN events among the 4590 patients in the derivation cohort with a median 3 (IQR 2-5) chemotherapy cycles. The FENCE risk groups* (0/+25/+25/+30 points for low/intermediate/high/very high risk), anaemia (+15 points), chemotherapy drugs (+9/+11 for platinums/taxanes), concurrent radiotherapy (+19 points), prophylactic G-CSF (-14 points), previous FN or neutropenia (0/+19/+43/+59 points for no neutropenia/neutropenia/1 FN event/>1 FN event in previous cycles), and cycle number (0/-9/-11/-12/-19 points for cycle 2/3/4/5/6) predicted FN. Discrimination of the CSRFENCE score was good with a Harrells C-statistic of 0.79 (95%CI, 0.77-0.82) and similar in the validation cohort (Table 1). Numbers needed to treat with G-CSF to avoid one FN event over 21 days were 748, 121, and 34 in the low, intermediate, and high risk groups, respectively.
Conclusion: We developed and validated a risk score to predict FN in cycles two to six of chemotherapy. The CSRFENCE score provides good differentiation of risk groups but needs validation.
* Aagaard et al. Poster 2352. IDWeek; 2017; San Diego, CA.
A. Roen, None
G. Daugaard, None
H. Sengeløv, None
L. Specht, Takeda: Investigator and Scientific Advisor , Consulting fee and Research support . Merck: Scientific Advisor , Consulting fee . Varian Medical Systems: Research agreement , Research grant . Merck Serono: Research agreement , Research support . Nanovi: Investigator , Consulting fee and Research support .
A. Mocroft, None
J. Lundgren, None
M. Helleberg, None
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