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Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients

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Abstract

The purpose of this study was to determine if the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score is able to predict the outcome of febrile neutropenia in patients with underlying hematological malignancy and to look at the other possible predictors of outcome. A retrospective study of 116 episodes of febrile neutropenia in patients who were admitted to the hematology ward of a local medical center in Malaysia between January 1st 2004 and January 31st 2005. Patient characteristics and the MASCC score were compared with outcome. The MASCC score predicted the outcome of febrile neutropenic episodes with a positive predictive value of 82.9%, a sensitivity of 93%, and specificity of 67%. Other predictors of a favorable outcome were those patients who had lymphomas versus leukemias, duration of neutropenia of less than 7 days, low burden of illness characterized by the absence of an infective focus and absence of lower respiratory tract infection, a serum albumin of >25 g/l, and the absence of gram-negative bacteremia on univariate analysis but only serum albumin level, low burden of illness, and presence of respiratory infection were significantly associated with unfavorable outcome after multivariate analysis. The MASCC score is a useful predictor of outcome in patients with febrile neutropenia with underlying hematological malignancies. This scoring system may be adapted for use in local settings to guide the clinical management of patients with this condition.

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References

  1. Bodey GP, Buckley M, Sathe YS et al (1996) Quantitative relationship between circulating leukocytes and infections in patients with acute leukemia. Ann Intern Med 64:328–339

    Google Scholar 

  2. Cengiz O, Kucer B, Sürmeli S, Santicky MJ, Soran A (2006) Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma. Med Sci Monit 12(6):CR240–CR247

    PubMed  CAS  Google Scholar 

  3. Chen HP, Chen TL, Lai CJ, Fung CP, Wong WW, Yu KW, Liu CY (2005) Predictors of mortality in Acinetobacter baumanii bacteremia. J Microbial Immunol Infect 38:127–136

    Google Scholar 

  4. Cherif H, Johansson E, Bjorkholm K, Kalin M (2006) Feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica 91:215–222

    PubMed  Google Scholar 

  5. de Souza Viana L, Serufo JC, da Costa Rocha MO, Costa RN, Duarte RC (2007) Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer Oct 25 (ahead of print)

  6. Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamerellou H (2001) Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infec Dis 32:1715–1725

    Article  Google Scholar 

  7. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  8. Innes H, Lim SL, Hall A, Chan SY, Bhalla N, Marshall E (2007) Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support Care Cancer Sep 25 (ahead of print)

  9. Kern WV (2001) Risk assessment and risk based therapeutic strategies in febrile neutropenia. Curr Opin Infect Dis 14:415–222

    PubMed  CAS  Google Scholar 

  10. Klaassen RJ, Goodman TR, Pham B, Doyle JJ (2000) “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol 18:1012–1019

    PubMed  CAS  Google Scholar 

  11. 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 18:3038–3051

    PubMed  CAS  Google Scholar 

  12. Klastersky J, Ameye L, Maertens J, Georgala A, Muanza F, Aoun M, Ferrant A, Rapoport B, Rolston K, Paesmans M (2007) Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 30:S51–S59

    Article  PubMed  CAS  Google Scholar 

  13. Lai CH, Chi CY, Chen HP, Chen TL, Lai CJ, Fung CP, Yu KW, Wong WW, Liu CY (2004) Clinical characteristics and prognostic factors for patients with Stenotrophomonas maltophilia bacteremia. J Microbial Immunol Infect 37:350–358

    Google Scholar 

  14. McCabe WR, Jackson GG (1962) Gram negative bacteremia: etiology, clinical, laboratory, and therapeutic observations. Arch Intern Med 110:847–865

    Google Scholar 

  15. Neth O, Hann I, Turner MW, Klein NJ (2001) Deficiency of mannose-binding lectin and burden of infection in children with malignancy: a prospective study. Lancet 358:614–618

    Article  PubMed  CAS  Google Scholar 

  16. Ohyashki K (2004) Monotherapy versus dual therapy based on risk categorization of febrile neutropenic patients. Clin Infect Dis 39:56–58

    Article  Google Scholar 

  17. Rubin M, Hathorn JW, Pizzo PA (1988) Controversies in the management of febrile neutropenic cancer patients. Cancer Invest 6:167–184

    Article  PubMed  CAS  Google Scholar 

  18. Santolaya ME, Alvarez AM, Becker A et al (2001) Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia and fever. J Clin Oncol 19:3415–3421

    PubMed  CAS  Google Scholar 

  19. Secmeer G, Devrim I, Kara A et al (2007) Role of procalcitonin and CRP in differentiating a stable from a clinical deteriorated course in pediatric febrile neutropenia. J Pediatr Hemat Oncol 29:107–111

    Article  CAS  Google Scholar 

  20. Alici S, Kaya S, Izmirli M et al (2006) Analysis of survival factors in patients with advanced stage gastric adenocarcinoma. Med Sci Monit 12(5):CR221–CR229

    PubMed  Google Scholar 

  21. Talcott JA, Finberg R, Mayer RJ et al (1988) The medical course of cancer patients with fever and neutropenia. Arch Internal Med 148:2501–2568

    Article  Google Scholar 

  22. Talcott JA, Siegel RD, Finberg R et al (1992) Risk assessment in cancer patients with fever and neutropenia; a prospective, two-centre validation of a prediction rule. J Clin Oncol 10:316–322

    PubMed  CAS  Google Scholar 

  23. Uys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score. Support Care Cancer 12:555–560

    Article  PubMed  Google Scholar 

  24. Viscoli C (2002) EORTC International Antimicrobial Therapy Group. Management of infection in cancer patients: studies of the EORTC International Antimicrobial Therapy Group (IATG). Eur J Cancer 38:S82–S87

    Article  PubMed  Google Scholar 

  25. Viscoli C, Castagnola E (2002) Treatment of febrile neutropenia: what is new. Curr Opin Infect Dis 15:377–382

    PubMed  Google Scholar 

  26. Yadegarynia D, Tarrand J, Raad I, Rolston K (2003) Current spectrum of bacterial infections in patients with cancer. Clin Infec Dis 37:1144–1145

    Article  CAS  Google Scholar 

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Correspondence to Gin Gin Gan.

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Baskaran, N.D., Gan, G.G. & Adeeba, K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 87, 563–569 (2008). https://doi.org/10.1007/s00277-008-0487-7

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  • DOI: https://doi.org/10.1007/s00277-008-0487-7

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