Abstract
Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM) may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group) and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02). Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients.
Highlights
A significant improvement in the outcome of patients with hematological malignancies has been observed, mainly due to progress in treatment and supportive care [1,2]
The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-a), soluble TNF-a I and II receptors, monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1a (MIP-1a or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients
CCL2 did not present a satisfactory discriminatory performance, with an accuracy of less than 50%. This exploratory study whose objective was to use the levels of circulating inflammatory molecules to predict the occurrence of fever in onco-hematological patients with chemotherapy-induced or disease-related neutropenia
Summary
A significant improvement in the outcome of patients with hematological malignancies has been observed, mainly due to progress in treatment and supportive care [1,2]. In spite of the indisputable advance in the management of these patients, many clinical challenges remain, such as opportunistic infections, drug toxicity, and hemorrhages [3,4]. Infectious complications related to neutropenia are the leading cause of morbidity and mortality in onco-hematological patients. Management of infections in neutropenic patients is especially challenging owing to their nonspecific signs and symptoms. Fever is regarded as an early warning sign in patients with neutropenia, and all guidelines recommend prompt use of broad-spectrum antibiotic therapy when it occurs [5,6,7]
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