Supportive Care in Cancer

, Volume 16, Issue 7, pp 841–846 | Cite as

Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients

  • Luciano de Souza VianaEmail author
  • José Carlos Serufo
  • Manoel Otávio da Costa Rocha
  • Renato Nogueira Costa
  • Roberto Carlos Duarte
Original Article


Goals of work

This is a prospective and observational study comparing the efficacy of risk-assessment models in patients with neutropenic fever in a reference treatment center. The meaning of the complex infection was evaluated.

Materials and methods

Patients were recruited throughout a 9-month period. Inclusion criteria were histologic diagnosis of malignancy, neutropenic febrile secondary to chemotherapy and/or radiotherapy (absolute neutrophil count of <500/µl and axillary temperature ≥38°C), and ≥18 years of age.

Main results

Fifty-three febrile neutropenic patients were included. Twenty one of them were classified as low risk by the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the MASCC risk-index scores were, respectively 87.9, 85.0, 90.6, 80.9, and 86.8%. None of the low-risk patients died, but four patients classified as low risk by the MASCC model developed serious medical complications during febrile neutropenic episodes. When we subtracted patients with complex infections from the group of patients with the MASCC risk-index score of ≥21, we got 15 patients that were classified as low risk by a proposed adjustment by complex infection (PACI) model. None of them developed serious medical complications. The sensitivity, specificity, PPV, NPV, and the accuracy of this new model were, respectively, 100, 75.0, 86.8, 100, and 90.6%.


The MASCC risk-index score had high sensitivity and specificity to predict the absence of complications, but the PACI model was better than MASCC for predicting the absence of complications in this febrile neutropenic patients.


Neutropenic fever Infections Fever Neutropenia 



We are indebted to all members of the Departments of Medical Oncology and Internal Hematology of the Felicio Rocho Hospital.


  1. 1.
    Chamilos G, Bamias A, Efstathiou E et al (2005) Outpatient treatment of low-risk neutropenic fever in cancer patients using oral moxifloxacin. Cancer 103(12):2629–2635PubMedCrossRefGoogle Scholar
  2. 2.
    Cherif H, Johansson E, Bjorkholm M et al (2006) The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica 91(2):215–222PubMedGoogle Scholar
  3. 3.
    Donowitz GR, Maki DG, Crnich CJ, et al (2001) Infections in the Neutropenic Patient - New Views of an Old Problem. In: ANNUAL MEETING OF THE AMERICAN SOCIETY OF HEMATOLOGY, 43TH., 2001, Orlando. Education Program Book: Hematology (Am Soc Hematol Educ Program):113–139Google Scholar
  4. 4.
    Elting LS, Rubenstein EB, Rolston KV et al (1997) Outcomes of bacteremia in patients with cancer and neutropenia: Observations from two decades of epidemiological and clinical trials. Clin Infect Dis 25(2):247–259PubMedCrossRefGoogle Scholar
  5. 5.
    Escalante CP, Weiser MA, Manzullo E et al (2004) Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients. Support Care Cancer 12(9):657–662PubMedGoogle Scholar
  6. 6.
    Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34(6):730–751PubMedCrossRefGoogle Scholar
  7. 7.
    Kern WV (2006) Risk assessment and treatment for low-risk patients with febrile neutropenia. Clin Infect Dis 42(4):533–540PubMedCrossRefGoogle Scholar
  8. 8.
    Klastersky J, Paesmans M, Rubenstein EB et al (2000) The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18(16):3038–3051PubMedGoogle Scholar
  9. 9.
    Nijhuis CO, Kamps WA, Daenen SM et al (2005) Feasibility of withholding antibiotics in selected febrile neutropenic cancer patients. J Clin Oncol 23(30):7437–7444CrossRefGoogle Scholar
  10. 10.
    Paesmans M (2000) Risk factors assessment in febrile neutropenia. Int J Antimicrob Agents 16(2):107–111PubMedCrossRefGoogle Scholar
  11. 11.
    Sipsas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103(6):1103–1113PubMedCrossRefGoogle Scholar
  12. 12.
    Rolston KV (2003) Oral antibiotic administration and early hospital discharge is a safe and effective alternative for treatment of low-risk neutropenic fever. Cancer Treat Rev 29(6):551–554PubMedCrossRefGoogle Scholar
  13. 13.
    Rolston KV (1999) New trends in patient management: Risk-based therapy for febrile patients with neutropenia. Clin Infect Dis 29(3):515–521PubMedCrossRefGoogle Scholar
  14. 14.
    Talcott JA, Finberg R, Mayer RJ et al (1988) The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation. Arch Intern Med 148(12):2561–2568PubMedCrossRefGoogle Scholar
  15. 15.
    Uys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer 12(8):555–560PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Luciano de Souza Viana
    • 1
    • 2
    • 3
    Email author
  • José Carlos Serufo
    • 1
  • Manoel Otávio da Costa Rocha
    • 1
  • Renato Nogueira Costa
    • 2
  • Roberto Carlos Duarte
    • 2
  1. 1.Infectious Disease and Tropical MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  2. 2.Departments of Medical Oncology and Internal HematologyFelicio Rocho HospitalBelo HorizonteBrazil
  3. 3.BarretosBrazil

Personalised recommendations