1549. Development and Validation of a Cycle-Specific Risk Score for Febrile Neutropenia After Chemotherapy in Patients with Cancer: The CSRFENCE Score

Abstract

BackgroundPrediction of febrile neutropenia (FN) with initiation of preventive measures in high-risk populations may lead to better outcomes in cancer treatment. We have previously developed a score to predict FN in the first cycle of chemotherapy.1 We aimed to develop and validate a cycle-specific score to predict FN in cycles two to six as guidelines recommend assessing the risk of FN at each cycle start.MethodsWe included consecutive patients with solid cancers at Rigshospitalet, University of Copenhagen, 2010–2016. FN was defined as neutrophils <0.5 × 109/L or leukocytes ≤2.0 × 109/L at the time of either a blood culture sample or death. Predictors of FN were analysed using Poisson regression adjusted for repeated measurements using 2:1 random split sampling. Risk factors assessed were: FENCE risk groups,1 sex, body surface area, Charlson Comorbidity Index score, haemoglobin, leukocyte and platelet levels, chemotherapy drugs, radiotherapy, prophylactic granulocyte colony-stimulating factors (G-CSF), previous FN or neutropenia, dose delays, dose reductions, and cycle number. Parameter estimates were scaled and summed to create the risk score.ResultsThere were 324 FN events among the 4,590 patients in the derivation cohort with a median 3 (IQR 2–5) chemotherapy cycles. The FENCE risk groups1 (0/+25/+25/+30 points for low/intermediate/high/very high risk), anaemia (+15 points), chemotherapy drugs (+9/+11 for platinums/taxanes), concurrent radiotherapy (+19 points), prophylactic G-CSF (−14 points), previous FN or neutropenia (0/+19/+43/+59 points for no neutropenia/neutropenia/1 FN event/>1 FN event in previous cycles), and cycle number (0/−9/−11/−12/−19 points for cycle 2/3/4/5/6) predicted FN. Discrimination of the CSRFENCE score was good with a Harrell’s C-statistic of 0.79 (95% CI 0.77–0.82) and similar in the validation cohort (Table 1). Numbers needed to treat with G-CSF to avoid one FN event over 21 days were 748, 121, and 34 in the low-, intermediate-, and high-risk groups, respectively. ConclusionWe developed and validated a risk score to predict FN in cycles two to six of chemotherapy. The CSRFENCE score provides good differentiation of risk groups but needs validation.Reference1. Aagaard et al. Poster 2352. IDWeek; 2017; San Diego, CA.Disclosures L. Specht, Takeda: Investigator and Scientific Advisor, Consulting fee and Research support; Merck: Scientific Advisor, Consulting fee; Varian Medical Systems: Research agreement, Research grant; Merck Serono: Research agreement, Research support; Nanovi: Investigator, Consulting fee and Research support.