The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients

Purpose: Febrile neutropenia remains a potentially life-threatening complic ation of anticancer chemotherapy, but some patients are at low risk for ser ious medical complications. The purpose of this study was to develop an int ernationally validated scoring system to identify these patients. Materials and Methods: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected deriva tion set, were assigned integer weights to develop a risk-index score, whic h was subsequently tested on ct validation set. Results: On the derivation get (756 patients), predictive factors were a bu rden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21;95% confidence interval [CI], 4.15 to 16.38) or mode rate symptoms (weight, 3; OR, 3.70; 95% CI, 2.18 to 6.29); absence of hypot ension (weight, 5; OR, 7.62; 95% CI, 2.91 to 19.89); absence of chronic obs tructive pulmonary disease (weight, 4; OR, 5.35; 95% CI, 1.86 to 15.46); pr esence of solid tumor or absence of previous fungal infection in patients w ith hematologic malignancies (weight, 4,OR, 5.07; 95% CI, 1.97 to 12.95); o utpatient status (weight, 3; OR, 3.51; 95% Cl, 2.02 to 6.04); absence of de hydration (weight, 3; OR, 3.81; 95% Cl, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95% CI, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score greater than or equal to 21 identified law-risk patients with a positive pr edictive value of 91%, specificity of 68%, and sensitivity of 71%. Conclusion: The risk index accurately identifies patients at low risk for c omplications and may be used to select patients for testing therapeutic str ategies that may be more convenient or cast-effective, (C) 2000 by American Society of Clinical Oncology.