Prophylaxis of febrile neutropenia in adults receiving chemotherapy needs to be adapted to the risk

Abstract

A major advance in the management of febrile neutropenia (FN) has been the stratification of the population of adult patients with FN for the risk of complications and death. Using validated reliable predictive instruments, such as the Multinational Association for Supportive Care in Cancer score, it is possible to identify a population of ‘low-risk’ patients, who can benefit from simplified and less expensive therapeutic approaches (e.g., orally administered antimicrobial therapy and early home return). Prevention of FN by the use of granulopoietic colony-stimulating factor (G-CSF) has been successfully applied to patients at ‘high risk’ of developing FN. In addition to the aggressiveness of chemotherapy, which usually defines the ‘high-risk’ status, the role of a series of factors that increase both the risk of FN and the complications rate has been recognized and should probably be taken into consideration when selecting patients for G-CSF prophylaxis. The cost of the G-CSF is the major limiting factor for their broad use; further efforts should be made to match the cost issue with the need of protecting from the development of FN most patients treated with chemotherapy for cancer.

Keywords:

• chemotherapy
• febrile neutropenia
• granulopoietic growth factors
• prevention
• risk prediction

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was used in the production of this article.

Key issues

• Febrile neutropenia (FN) in chemotherapy (CT)–treated patients remains an important cause of mortality, morbidity, extra costs and reduction of the efficacy of cancer treatment.

• All the CT-treated patients are not at the same risk of developing complications during an episode of FN; using predictive tools, such as the MASCC scoring system, it is possible to propose a simplified and less expensive therapy to a substantial proposition of patients with FN.

• Granulopoietic growth factors are highly effective to prevent FN in a significant proposition of CT-treated patients. Relatively high prices remain a limitation for their use and the balance between clinical benefit and cost should be further studied.

Notes