Risk assessment model for first-cycle chemotherapy-induced neutropenia in patients with solid tumours

A López-Pousa,A Casas De Tejerina,J.A Gasquet,J Rifà,C Iglesias,A Carrato,J.L González-Larriba

doi:10.1111/j.1365-2354.2009.01121.x

Abstract

LÓPEZ-POUSA A., RIFÀ J., CASAS DE TEJERINA A., GONZÁLEZ-LARRIBA J.L., IGLESIAS C., GASQUET J.A. & CARRATO A. (2010) European Journal of Cancer Care Risk assessment model for first-cycle chemotherapy-induced neutropenia in patients with solid tumoursChemotherapy-induced neutropenia, the major dose-limiting toxicity of chemotherapy, is directly associated with concomitant morbidity, mortality and health-care costs. The use of prophylactic granulocyte colony-stimulating factors may reduce the incidence and duration of chemotherapy-induced neutropenia, and is recommended in high-risk patients. The objective of this study was to develop a model to predict first-cycle chemotherapy-induced neutropenia (defined as neutropenia grade ≥3, with or without body temperature ≥38°C) in patients with solid tumours. A total of 1194 patients [56% women; mean age 58 ± 12 years; 94% Eastern Cooperative Oncology Group (ECOG) status ≤1] with solid tumours were included in a multi-centre non-interventional prospective cohort study. A predictive logistic regression model was developed. Several factors were found to influence chemotherapy-induced neutropenia. Higher ECOG status values increased toxicity (ECOG 2 vs. 0, P= 0.003; odds ratio 3.12), whereas baseline lymphocyte (P= 0.011; odds ratio 0.67) and neutrophil counts (P= 0.026; odds ratio 0.90) were inversely related to neutropenia occurrence. Sex and treatment intention also significantly influenced chemotherapy-induced neutropenia (P= 0.012). The sensitivity and specificity of the model were 63% and 67% respectively, and the positive and negative predictive values were 17% and 94% respectively. Once validated, this model should be a useful tool for clinical decision making.

Highlights

Patients receiving myelosuppressive chemotherapy frequently develop severe neutropenia or febrile neutropenia
Myelosuppressive chemotherapy regimens are regularly used to treat a wide variety of malignancies, and chemotherapy-induced neutropenia is one of the major dose-limiting toxicities seen in clinical oncology practice
Two basic types of models have been developed to predict neutropenia, which can be found in the literature: conditional models, which are based on patient toxicity during the first chemotherapy cycle, and unconditional models, which are dependent on pretreatment values (Crawford et al 2004; Lyman et al 2005)

Summary

Introduction

Patients receiving myelosuppressive chemotherapy frequently develop severe neutropenia or febrile neutropenia. Myelosuppressive chemotherapy regimens are regularly used to treat a wide variety of malignancies, and chemotherapy-induced neutropenia is one of the major dose-limiting toxicities seen in clinical oncology practice. Chemotherapy-induced neutropenia will become an even greater issue as elderly populations increase in developed countries, leading to a higher prevalence of cancers and an increase in the age-related risk of chemotherapy-induced neutropenia (Lyman et al 2003). The reported incidence and prevalence of neutropenia vary widely. One of the most reliable estimates cited in the literature suggests an incidence of 7.83 neutropenic hospitalisations per 1000 cancer patients (Caggiano et al 2005). In the USA, reported inpatient mortality rates associated with grades 3 and 4 neutropenia range from 3.4% to 10.5%, with an overall mortality ranging from 6.8% to 9.5% (Crawford et al 2004; Caggiano et al 2005; Kuderer et al 2006)

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