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Infection Study Group

Survey 1.

Febrile neutropenia remains a life-threatening complication of cancer chemotherapy and the classical therapeutic strategy consisted to treat the patients with a broad spectrum of intravenous antibiotics in a hospital setting although it was recognized that a quite large proportion of patients presents a rapid and complete response. So, there was clearly a need for a tool allowing identification of patients who could return quickly to normal temperature without development of any medical complication. There was already a clinical prediction rule for complication development developed and validated by Talcott and his colleagues (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 148:2561-2568, 1988). However, this classification depends on the hospitalization status of the patients, which can vary from country to country, from institution to institution or change due to the development of new anticancer strategies. Furthermore, it was felt that the sensitivity of the rule might be improved. The primary objective of the survey consisted in the identification of independent predictive factors assessable at fever onset among a patients population of adult febrile neutropenic cancer patients treated by chemotherapy. These factors were combined into a score associated to the probability of resolution without serious medical complication of febrile neutropenia The second objectives included response to empiric therapy infection documentation, bacteremia development and fever duration.

The score that was developed is the following:

MASCC risk-index score

 Characteristic  weight
 Burden of febrile neutropenia with no or mild symptoms  5
 No hypotension (systolic BP > 90 mm Hg)  5
 No chronic obstructive pulmonary disease  4
 Solid tumor or hematological malignancy with no previous fungal infection  4
 No dehydration requiring parenteral fluids  3
 Burden of febrile neutropenia with moderate symptoms  3
 Outpatient status  3
 Age <60 years  2


N.B.

Burden of febrile neutropenia refers to the general clinical status of the patient as influenced by the febrile neutropenic episode. It should be evaluated on the following scale:

  1. no symptoms (score of 5 points)
  2. mild symptoms (score of 5 points)
  3. moderate symptoms (score of 3 points)
  4. severe symptoms (score of 0)
  5. moribund (score of 0)
  • Chronic obstructive pulmonary disease means active chronic bronchitis, emphysema, decrease in FEVs, need for oxygen therapy and/or steroids and/or bronchodilators
  • Previous fungal infection means demonstrated fungal infection or empirically treated suspected fungal infection
  • The points attributed to the variable " burden of febrile neutropenia " are not cumulative.
    The maximal theoretical score is therefore 26.
  • The threshold for low-risk is a score ³ 21.

The survey was open for patients registration between December 1994 and October 1997. The results were published in August 200 in the Journal of Clinical Oncology. More information can be found using the following PubMed Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed

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