Early lymphopenia as a risk factor for chemotherapy‐induced febrile neutropenia

Abstract

Febrile neutropenia (FN) is a frequent complication of cancer chemotherapy, which causes death in 4-21% of patients and worsens the quality of life of patients. As a simple and accurate way of identifying patients who are at risk of FN, a lymphocyte count on post-chemotherapy day 5 was suggested. To confirm the feasibility of this method and to define the incidence of FN among our own patient group, we conducted this prospective study. From September 2001 to February 2002, patients who received cytotoxic chemotherapy at Guro Hospital, Korea University, were enrolled. Blood sampling for a complete blood count was done on the starting day of chemotherapy and on day 3 and day 5 post-chemotherapy. The prospective results of the CBC were compared between the FN group and non-FN group. During the study period, 82 patients were enrolled. The male to female ratio was 52:30, and the median age was 56 years old (range: 14-78). Underlying malignancies were non-Hodgkin's lymphoma (14 patients), stomach cancer (17), breast cancer (11), NSCLC (7), hepatobiliary cancer (10), sarcoma (3), colorectal cancer (3), and others (17). The incidence of FN was 18% (15/82 patients), and ANC at the time of FN was 275 ± 327/µl. Duration of fever was 3.9 ± 3.5 days. The incidence of FN was significantly higher in patients with lymphocyte counts at day 3 ≤ 500/µl (P = 0.06), day 5 ≤ 500/µl (P = 0.023), day 3 ≤ 700/µl (P = 0.01), and day 5 ≤ 700/µl (P = 0.0001). As a result of a logistic regression test, a day-5 lymphocyte count ≤ 700/µl was identified as an independent risk factor for FN.In conclusion, a day-5 lymphocyte count <700/µl was a risk factor for FN. To strengthen our result, we are planning to validate in a larger patient group. Am.

Clinical Predictive Models for Chemotherapy-Induced Febrile Neutropenia in Breast Cancer Patients: A Validation Study

“…A predictive model could also be helpful for patients with an intermediate risk of FN (10–20%) when the use of prophylactic CSF is determined by the physician. Several models have been developed and widely validated in cancer patients[9], [14], [16], [19], [22], [24]. However, few models have been developed specifically for breast cancer patients.…”

“…These factors, however, are not a direct reflection of the granulocyte reservoir or the stem cell pool of the bone marrow. Therefore, pretreatment hematological parameters, such as white blood cell count[18], platelet count[19], absolute neutrophil count (ANC) [20], [21], absolute lymphocyte count (ALC) [22], [23] or absolute monocyte count (AMC) [16], [19], [24], are hypothesized to reflect, to some extent, the patient’s predisposition to FN. Jenkins et al developed a model using pretreatment ANC and ALC in breast cancer patients receiving CEF (5-fluorouracil, epirubicin and cyclophosphamide) chemotherapy[20].…”

Risk factors for febrile neutropenia in patients receiving docetaxel chemotherapy for castration-resistant prostate cancer

“…However, The results of the present study suggest that severe posttreatment lymphopenia may identify a subgroup of CRPC patients treated with docetaxel who are at high risk for FN. Several previous studies have consistently shown that posttreatment lymphopenia is a predictive factor for FN among adult and pediatric patients treated with several chemotherapy regimens [26][27][28].…”

Febrile neutropenia recurrence after chemotherapy in patients with breast cancer / Neutropenia febril de recorrência pós quimioterapia em paciente com câncer de mama / Febril recurrencia neutropenia después de la quimioterapia en pacientes con cáncer...

“…Entretanto, a taxa de complicações decorrentes é elevada, acarretando importante morbidade e mortalidade, a taxa de óbitos varia de 4% a 21% (8) . Esta condição está associada ainda a um aumento importante nos custos do manejo das pacientes com câncer de mama (7,(9)(10) .…”