Incidence, Risk Factors, and Outcomes of Febrile Neutropenia in Thai Hematologic Malignancy Patients Receiving Chemotherapy: A 6-year Retrospective Cohort Study.

Wasithep Limvorapitak,Thana Khawcharoenporn

doi:10.7314/apjcp.2015.16.14.5945

Wasithep Limvorapitak, Thana Khawcharoenporn

Open Access

https://doi.org/10.7314/apjcp.2015.16.14.5945

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Abstract

A 6-year retrospective cohort study was conducted among Thai hematologic malignancy (HM) patients receiving intensive chemotherapy. Of the 145 eligible patients receiving 893 chemotherapy sessions, 46.9% were female, median age was 52 years, and the most common HM diagnosis was diffuse large B-cell lymphoma (46.2%). Febrile neutropenia (FN) occurred in 14.9% of chemotherapy sessions with an incidence of 24.8 per 1,000 chemotherapy cycles per year. Independent factors associated with FN were receiving the first chemotherapy cycle [adjusted hazard ratio (aHR) 4.1], having hemoglobin ≤100 g/L (aHR 3.7) and platelet ≤140,000/μL (aHR 2.7) on chemotherapy day and receiving acute myeloid leukemia regimens (aHR 20.8). Granulocyte colony stimulating factor was significantly associated with reduced rate of FN when given in those receiving CHOP regimen. With the median follow-up time of 16 months, the overall survival time was significantly longer in patients without FN than those with FN (61.7 vs. 20.8 months; p<0.001).

Highlights

Febrile neutropenia (FN) is a common complication of solid and hematologic malignancies (HM) and occurs as a result of bone marrow involvement and/or the treatment of the diseases
The incidence rate of FN in our study was 14.9% in hematologic malignancy (HM) patients receiving intensive chemotherapy, which was consistent with the overall rate of FN in HM patients reported in the previous studies (Wolff et al, 2005; Pettengell et al, 2009), while the annual incidence of FN was 24.8 per 1,000 chemotherapy cycles
Independent risk factors associated with FN occurrence in our HM patients included receipt of the first cycle of chemotherapy, having hemoglobin level less than 100 g/L, and platelet less than 140,000/μL on the first day of chemotherapy

Summary

Introduction

Febrile neutropenia (FN) is a common complication of solid and hematologic malignancies (HM) and occurs as a result of bone marrow involvement and/or the treatment of the diseases. Febrile neutropenia poses risk for developing severe infections that sometimes results in mortality. Etiologic organisms may be bacteria, viruses, fungi or other microorganisms depending on the net state of immune suppression. Symptoms and signs of febrile neutropenic patients may be subtle due to the immune effector mechanism suppression. The infectious foci may not be readily identified and empirical antibiotics need to be promptly administered. Delay in appropriate treatment of FN may results in significant morbidity and mortality of these patients

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