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Development of a simplified multivariable model to predict neutropenic complications in cancer patients undergoing chemotherapy

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Abstract

Purpose

Neutropenic complications remain the major dose-limiting toxicities of cancer chemotherapy. The aim of this study was to develop and internally validate a comprehensive and easily measurable scoring system for prediction of severe or febrile neutropenia in the first chemotherapy cycle of patients with solid tumors or lymphoma.

Methods

This prospective cohort study included consecutive patients at a tertiary referral hospital. Many clinical and laboratory-independent variables were measured at baseline. A multivariable logistic regression analysis was applied after unadjusted analysis, and the multivariable model was transformed into a simplified risk score based on 6 bootstrapped regression coefficients. The simplified scoring system was internally validated using cross-validation. All statistical tests were two-sided.

Results

A total of 305 patients were enrolled and followed during 1732 chemotherapy cycles. Of these, 259 were eligible for analysis. The multivariable model revealed 6 predictive factors for severe or febrile neutropenia (scores in parentheses): high-risk regimen without colony-stimulating factor (4 points), intermediate-risk regimen without colony-stimulating factor (3 points), age > 65 years and elevated ferritin (3 points), body mass index < 23 kg/m2 and body surface area < 2 m2 (2 points), estimated glomerular filtration rate < 60 mL/min/1.73m2 (2 points), and elevated C-reactive protein (1 point). The receiver operating characteristic curve was 0.832 (95% confidence interval [Cl], 0.767–0.897) for the simplified model and 0.816 (95% Cl, 0.771–0.860) for the cross-validation.

Conclusions

We developed and internally validated a user-friendly prediction model to guide personalized decision-making using available clinical data and few cost-effective laboratory tests. External validation in other centers with different patients is required.

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Acknowledgements

This study was supported by Shahid Beheshti University of Medical Sciences [grant number 6620] and Behnam Daheshpour Charity Organization. The funders of this study were not involved in performing the study (e.g., data collection, analysis, and interpretation) as well as preparation of this report. We would like to thank Dr. A. Rezazadeh Mafi for critically reading the manuscript and Drs. H.R. Mirzaei, A. Rakhsha, A. Mousavizadeh, M. Malekzadeh, A.S. Yousefi Kashi, M. Houshyari, P. Hajian, and S. Azghandi for providing the patient data. We also thank the nursing staff of the oncology ward, especially Mrs. P. Peyghambarlou, for the administrative assistance.

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Authors and Affiliations

  1. Urology and Nephrology Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Abolfazl Razzaghdoust

  2. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Bahram Mofid

  3. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Bahram Mofid

  4. Department of Radiation Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Shahrdari St, Tajrish Sq, Tehran, 1989934148, Iran

    Bahram Mofid & Maryam Moghadam

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  1. Abolfazl Razzaghdoust
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Correspondence to Bahram Mofid.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Razzaghdoust, A., Mofid, B. & Moghadam, M. Development of a simplified multivariable model to predict neutropenic complications in cancer patients undergoing chemotherapy. Support Care Cancer 26, 3691–3699 (2018). https://doi.org/10.1007/s00520-018-4224-z

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  • DOI: https://doi.org/10.1007/s00520-018-4224-z

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