The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients

Klastersky, Jean; Paesmans, Marianne; Rubenstein, Edward; Boyer, Michael; Elting, Linda S.; Feld, Ronald; Gallagher, James; Herrstedt, Jørn; Rapoport, Bernardo Leon; Rolston, Kenneth V. I.; Talcott, James A.

doi:10.1200/jco.2000.18.16.3038

Cited by 1,011 publications

(770 citation statements)

References 33 publications

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“…Safety was defined as the absence of any serious medical complication (SMC) resulting from infection after randomization. SMCs included death, complications requiring pediatric intensive care unit treatment, and potentially life-threatening complications as judged by the treating physician [3,17,18,23,24].…”

Section: Definitions Of Safety and Efficacymentioning

confidence: 99%

“…In adult oncology FN risk scores and corresponding risk-adapted strategies are internationally established. They define when and for which patients a step-down from intravenous to oral antimicrobial therapy, and from inpatient to outpatient management, is safe and efficacious [2,3]. The corresponding, updated European and U.S. guidelines for the management of FN apply to adult patients only [4,5].…”

Section: Introductionmentioning

confidence: 99%

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First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Brack

Bodmer

Simon

et al. 2012

Pediatric Blood & Cancer

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BackgroundThe standard treatment of fever in chemotherapy‐induced neutropenia (FN) includes emergency hospitalization and empirical intravenous antimicrobial therapy. This study determined if first‐day step‐down to oral outpatient treatment is not inferior to continued standard regarding safety and efficacy in children with low‐risk FN.ProcedureIn a randomized controlled non‐blinded multicenter study, pediatric patients with FN after non‐myeloablative chemotherapy were reassessed after 8–22 hours of inpatient intravenous antimicrobial therapy. Low‐risk patients were randomized to first‐day step‐down to experimental (outpatient, oral amoxicillin plus ciprofloxacin) versus continued standard treatment. Exact non‐inferiority tests were used for safety (no serious medical complication; non‐inferiority margin of difference, 3.5%) and efficacy (resolution of infection without recurrence, no modification of antimicrobial therapy, no adverse event; 10%).ResultsIn 93 (26%) of 355 potentially eligible FN episodes low‐risk criteria were fulfilled, and 62 were randomized, 28 to experimental (1 lost to follow‐up) and 34 to standard treatment. In intention‐to‐treat analyses, non‐inferiority was not proven for safety [27 of 27 (100%) vs. 33 of 34 (97%; 1 death) episodes; 95% upper confidence border, 6.7%; P = 0.11], but non‐inferiority was proven for efficacy [23 of 27 (85%) vs. 26 of 34 (76%) episodes; 95% upper confidence border, 9.4%; P = 0.045]. Per‐protocol analyses confirmed these results.ConclusionsIn children with low‐risk FN, the efficacy of first‐day step‐down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non‐inferior to continued hospitalization and intravenous antimicrobial therapy. The safety of this procedure, however, was not assessable with sufficient power. Pediatr Blood Cancer 2012;59:423–430. © 2012 Wiley Periodicals, Inc.

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Section: Definitions Of Safety and Efficacymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Brack

Bodmer

Simon

et al. 2012

Pediatric Blood & Cancer

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“…Our management of anti-cancer therapy induced anemia, febrile neutropenia or thrombocytopenia deviates substantially from the European, ASCO (American society of Clinical Oncology) guidelines (Groopman et al, 1999;de Naurois et al, 2010;Freifeld et al, 2011;Flowers et al, 2013). Though we did not analyse the MASCC score routinely in our study cohort, some of the important prognostic factors related to adverse outcome resembles the findings of other studies (Klastersky et al, 2000;Osmani et al, 2012).…”

Section: Discussionmentioning

confidence: 73%

Hematologic Toxicity in Patients Undergoing Radical Anti-cancer Therapy: A Cross-Sectional Analysis of Patients in an Oncology Ward in India

Roy

Mallick²,

Raza³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Fever may occur and persist in 40 % of these patients despite broad spectrum antimicrobial therapy [1,2]. The Multinational Association of Supportive Care in Cancer (MASCC) prognostic index suggests that the mortality rate is approximately 3 % if the MASCC score is [21; however, the mortality rate escalates to 36 % if the MASCC score is \15 [3]. Patients with bacteremia caused by Gram-negative bacteria were reported to have poor prognoses.…”

Section: Introductionmentioning

confidence: 99%

Which Multidrug-Resitant Bacteria are Emerging in Patients with Hematological Malignancies?: One-Year Report

Gedık

Şimşek²,

Yıldırmak³

et al. 2014

Indian J Hematol Blood Transfus

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The aim of this retrospective, observational study was to evaluate the outcomes of bacteremia attacks during neutropenic episodes caused by chemotherapy in patients with hematological cancers by assessing mortality, involved pathogens, antimicrobial therapy and treatment responses. Patients who were older than 14 years of age and developed at least one neutropenic episode after chemotherapy to treat hematological cancer between November 2011 and November 2012 were included in the study. We retrospectively collected demographic, treatment, and survival data for 68 patients with 129 neutropenic episodes. The mean age was 59.36 ± 15.22 years (range 17-80 years), and 41 cases were male. The mean Multinational Association of Supportive Care in Cancer score was 19.56 ± 9.04. A total of 37 (28 %) bacteremia attacks were recorded in 20 cases (29 %). Fatality rates were 50 % in the six cases with bacteremia caused by carbapenem-resistant Gram-negative bacteria; death occurred in two patients with carbapenem-resistant Acinetobacter baumannii and in one patient with carbapenem-resistant Pseudomonas aeruginosa. Clinical and microbiological responses were achieved using PIP-TAZ or CEP-SUL treatment in 80 % (16/20) of the cases with bacteremia caused by carbapenem-sensitive Gram-negative bacteria (CS-GNB). During 547 colonization-days in 21 (30 %) vancomycinresistant enterococci (VRE)-colonized cases among 68 patients, vancomycin-resistant Enterococcus faecium bacteremia developed in two patients. Non-carbapenem-based therapy can cure most bacteremia attacks caused by CS-GNB in patients with hematological cancer. However, bacteremia and other infections caused by drug-resistant pathogens, such as A. baumannii, P. aeruginosa, and VRE, are a growing concern in hematological patients.

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The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients

Abstract: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective.

Cited by 1,011 publications

References 33 publications

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Hematologic Toxicity in Patients Undergoing Radical Anti-cancer Therapy: A Cross-Sectional Analysis of Patients in an Oncology Ward in India

Which Multidrug-Resitant Bacteria are Emerging in Patients with Hematological Malignancies?: One-Year Report

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