Chemotherapy-induced neutropenia and fever in patients with metastatic breast carcinoma receiving salvage chemotherapy

Abstract

retrospective analysis, the authors evaluated the incidence of neutropenic fever, fever (41 episodes among 40 patients). The incidence of neutropenic fever did not Anderson Cancer Center, Houston, Texas.increase until the absolute neutrophil count (ANC) had decreased to less than 500/ mL, and then fever incidence had a linear relationship with decreasing ANC (linear trend, P õ 0.01). A source of infection was documented in 59% of the neutropenic fever episodes. The incidence of infection did not increase significantly until the ANC had decreased to less than 250/mL (P õ 0.01). The risk of neutropenic fever and infection was also significantly higher when patients had poor performance status or were undergoing the initial courses of chemotherapy. Patients with bone marrow metastases also had a higher frequency of fever, infection, and death, but these differences were not statistically significant. CONCLUSIONS.For patients with metastatic breast carcinoma receiving salvage chemotherapy, the risk of fever increases with decreasing ANC, but the risk of infection does not increase significantly until ANC decreases to less than 250/ mL. ship between infections and neutropenia was first described about 30 years ago in patients with acute leukemia receiving chemotherapy. 2Received July 29, 1996; revision received November 20, 1996; accepted November 20, 1996.Since then, considerable progress has been made in the management ᭧ 1997 American Cancer Society

Evidence for bistable bacteria-neutrophil interaction and its clinical implications

“…We propose that all major clinical observations regarding the development of infections in neutropenic patients are consistent with our model. First, the severity and duration of the neutropenic nadir are known to be correlated with increased risk of infection (1,18). The existence of the BNC indicates that the severity and duration of the nadir directly influence the likelihood of developing a severe infection, thus explaining the observed correlation.…”

“…Second, at some ranges of nadir levels and nadir durations, the risk of infection greatly increases (1,18). For these near-critical ranges, there was strong interpatient variability in infection development.…”

Predictors for chemotherapy-related severe or febrile neutropenia: a review of the clinical literature

“…Poo r perfo rm a nce statu s was d efined as WH O grade > 1; 15,24 Eastern Cooperative Oncology Group (ECOG) grade > 1; 18,[25][26][27] Zubrod's scale grade > 1; 28 or as grade > 1 using an undefined scale. 16 Four studies reported that poor performance status (PS> 1) was a significant risk factor (P= 0.002 to P< 0.000), 16,[26][27][28] while four other studies that examined performance status reported it not to be a significant risk factor. 15,18,24,25 One of these studies 24 defined neutropenia as grade 3 -4 and found performance status to be significant in univariate analysis; this factor did not remain an independent significant predictor in multivariate analysis.…”

Mathematical model for G-CSF administration after chemotherapy

“…In particular, chemotherapy often causes neutropenia since it typically attacks cells indiscriminately regardless of whether malignant or normal. In fact, neutropenia is one the most frequent side-effects of chemotherapy (Rahman et al, 1997;Vainstein et al, 2005). Administration of recombinant forms of the growth factor G-CSF has been shown to stimulate neutrophil production and is now the standard treatment for neutropenia.…”