CHEMOTHERAPY-INDUCED NEUTROPENIA AND FEVER IN PATIENTS WITH METASTATIC BREAST-CARCINOMA RECEIVING SALVAGE CHEMOTHERAPY

BACKGROUND. Chemotherapy-induced neutropenia and associated fever and infection are the most common complications of systemic chemotherapy. In this retrospective analysis, the authors evaluated the incidence of neutropenic fever, infection, and mortality in relation to the level of neutropenia, performance status, course number of chemotherapy, bon e marrow metastasis, and age among patients with metastatic breast car cinoma receiving salvage chemotherapy. METHODS. A total of 174 patient s with previously treated metastatic breast carcinoma enrolled on 4 co nsecutive Phase II protocols were evaluated. RESULTS, Twenty-three per cent of the patients had an episode of neutropenic fever (41 episodes among 40 patients). The incidence of neutropenic fever did not increas e until the absolute neutrophil count (ANC) had decreased to less than 500/mu L, and then fever incidence had a linear relationship with dec reasing ANC (linear trend, P < 0.01). A source of infection was as doc umented in 59% of the neutropenic fever episodes. The incidence of inf ection did not increase significantly until the ANC had decreased to l ess than 250/mu L (P < 0.01). The risk of neutropenic fever and infect ion was also significantly higher when patients had poor performance s tatus or were undergoing the initial courses of chemotherapy. Patients with bone marrow metastases also had a higher frequency of fever, inf ection, and death, but these differences were not statistically signif icant. CONCLUSIONS. For patients with metastatic breast carcinoma rece iving salvage chemotherapy, the risk of fever increases with decreasin g ANC, but the risk of infection does not increase significantly until ANC decreases io less than 250/mu L. Poor performance status, initial courses of chemotherapy, and bone marrow metastases further increase the risk of fever, infection, and death. (C) 1997 American Cancer Soci ety.