Factors related to | Factor | Effect on risk |
Patient characteristics | | - Risk increases if age ≥65 years[1]
|
| - Risk increases if ECOG performance score ≥2[1]
|
| - Risk increases if albumin <35 g/L[2,3]
|
- Prior neutropenic fever episode
| - Risk in cycles 2 to 6 is fourfold greater if neutropenic fever episode occurs in cycle 1[4]
|
| - Neutropenic fever odds increase by 27, 67, and 125% for one, two, or three or more comorbidities, respectively[1,5]
|
Underlying malignancy | | Diagnosis | Reported neutropenic fever rates (%) |
| 85.0 to 95.0[6-9] |
| 35.0 to 71.0*[10] |
| 27.0 (95% CI 19.0-34.5)[4,5,11,12] |
| 26.0 (95% CI 22.0-29.0)[4,5,11,12] |
| 23.0 (95% CI 16.6-29.0)[4,5,11,12] |
| 15.0 (95% CI 6.6-24.0)[4,5,11,12] |
| 12.0 (95% CI 6.6-17.7)[4,5,11,12] |
| 10.0 (95% CI 9.8-10.7)[4,5,11,12] |
| 5.5 (95% CI 5.1-5.8)[4,5,11,12] |
| 4.6 (95% CI 1.0-8.2)[4,5,11,12] |
| 4.4 (95% CI 4.1-4.7)[4,5,11,12] |
| 1.0 (95% CI 0.9-1.1)[4,5,11,12] |
| - Risk increases for advanced stage (≥2)[4]
|
| - Risk increases if not in remission[8,13]
|
- Cancer treatment response
| - Risk is lowest if patient has a CR
- If patient has a PR, neutropenic fever risk is greater for acute leukemia than for solid tissue malignancies[8]
- Neutropenic fever risk is higher in patients with persistent, refractory, or progressive disease despite treatment[14,15]
|
Treatment of malignancy | | Risk is higher with regimens that include: - Anthracyclines at doses ≥90 mg/m2
- Cisplatin at doses ≥100 mg/m2
- Ifosfamide at doses ≥9 g/m2
- Cyclophosphamide at doses ≥1 g/m2
- Etoposide at doses ≥500 mg/m2
- Cytarabine at doses ≥1 g/m2
- High dose density
- Anthracycline + taxane, and cyclophosphamide or gemcitabine, for breast cancer
|
| - Increased risk if >85% of scheduled doses are administered[12,16]
|
- Degree and duration of GI and/or oral mucositis
| - Risk is greatest if NCI mucositis grade is ≥3 (GI) or if peak score on OMAS is ≥2[9,17,18]
|
- Degree and duration of cytopenia
| - Profound, protracted neutropenia
| ANC <100/mcL for ≥7 days[19-21] |
| ALC <700/mcL (ANC surrogate)[11,22] |
| AMC <150/mcL (ANC surrogate)[23] |