The role of neutropenia on outcomes of cancer patients with community-acquired pneumonia

Abstract

Although the presence of neutropenia may predispose cancer patients to develop community-acquired pneumonia, the role of neutropenia on their outcomes has not been investigated. The purpose of the present study was to compare clinical outcomes of cancer community-acquired pneumonia patients with and without neutropenia.Patients with cancer, identified in the Community-Acquired Pneumonia Organization database, were divided into two groups according to the type of cancer and the presence of neutropenia: patients with solid cancer without neutropenia versus those with functional or absolute neutropenia. Among the 3,106 community-acquired pneumonia patients enrolled, 135 had cancer without neutropenia and 75 had cancer with neutropenia.No significant difference was found between patients with and without neutropenia regarding mean time to clinical stability (5.4¡2.7 versus 4.9¡2.7 days, respectively), mean length of hospital stay (9.2¡7.7 versus 9.9¡9.6 days) and in-hospital mortality (18 versus 15%, respectively). Using a multiple logistic regression model, neutropenia was not associated with mortality in cancer patients when adjusting for significant covariates (odds ratio 1.30).Lack of neutropenia, during the initial evaluation of a cancer community-acquired pneumonia patient, should not be considered an indicator of better clinical outcome.

Pulmonary infiltrates in patients with malignancies: why and how neutropenia influences clinical reasoning

“…However, among cancer patients, neutropenia did not influence time to clinical stability, length of hospital stay or in-hospital mortality. The study by ALIBERTI et al [21] is in agreement with most of the studies reported over the last decade, in which neutropenia has supplied no prognostic information in cancer patients with acute respiratory failure [22,23], even those requiring mechanical ventilation [24,25]. However, neutropenia has been associated with outcomes in studies focusing on the overall population of critically ill cancer patients [26][27][28].…”

“…In this issue of the European Respiratory Journal, ALIBERTI et al [21] compare clinical outcomes of cancer patients admitted for community-acquired pneumonia with (n573) or without (n5135) neutropenia. Overall, community-acquired pneumonia patients with cancer were found to have higher mortality rates than communityacquired pneumonia patients without cancer.…”

“…2) No information is available regarding the duration of neutropenia or the timing of neutropenia recovery. The results of ALIBERTI et al [21] come chiefly from patients with solid tumours, which are usually associated with far shorter chemotherapy-induced neutropenia duration (,5-7 days) than haematological malignancies. Different results would perhaps have been obtained in patients with refractory neutropenia or in recipients of allogeneic stem cell transplants [32,33].…”

Severe Septicemic Melioidosis in a Patient With Lung Adenocarcinoma Following Cytotoxic Chemotherapy

“…Most of the cases are related to neutropenic condition. During the past decades, the attention in management of infections in cancer patients has focused on fever and neutropenia [6][7][8]. However, latest guidelines by the National Comprehensive Cancer Network recommend that immunocompromised non-neutropenic cancer patients should receive equal attention as those with neutropenia [9].…”

“…Cytotoxic drugs used for the treatment of lung cancer can affect chemotactic and phagocytic function, without reflecting on the total cell count. The functional capabilities of phagocytes such as neutrophils, eosinophils and mononuclear cells may be intrinsically defective even before the initiation of chemotherapy [6].…”