Identification of patients at risk for early death after conventional chemotherapy in solid tumours and lymphomas

1-5% of cancer patients treated with cytotoxic chemotherapy die within a mo nth after the administration of chemotherapy. Risk factors for these early deaths (ED) are not well known. The purpose of this study was to establish a risk model for ED after chemotherapy applicable to all tumour types. The model was delineated in a series of 1051 cancer patients receiving a first course of chemotherapy in the Department of Medicine of the Centre Leon Ber ard (CLB) in 1996 (CLB-1996 cohort), and then validated in a series of pati ents treated in the same department in 1997 (CLB-1997), in a prospective co hort of patients with aggressive non-Hodgkin's lymphoma (NHL) (CLB-NHL), an d in a prospective cohort of patients with metastatic breast cancer (MBC se ries) receiving first-line chemotherapy. In the CLB-1996 series, 43 patient s (4.1%) experienced early. In univariate analysis, age > 60, PS > 1, lymph ocyte (ly) count less than or equal to 700 mul(-1) immediately prior to che motherapy (d1), d1-platelet count less than or equal to 150 GL(-1), and the type of chemotherapy were significantly correlated to the risk of early de ath (P less than or equal to 0.01). Using logistic regression, PS > 1 (haza rd ratio 3.9 (95% CI 2.0-7.5)) and d1-ly count less than or equal to 700 mu l(-1) (3.1 (95% CI 1.6-5.8)) were identified as independent risk factors fo r ED. The calculated probability of ED was 20% (95% CI 10-31) in patients w ith both risk factors, 6% (95% CI 4-9) for patients with only 1 risk factor , and 1.7% (95% CI 0.9-3) for patients with none of these 2 risk factors. I n the CLB-97, CLB-NHL and MBC validation series, the observed incidences of early death in patients with both risk factors were 19%, 25% and 40% respe ctively and did not differ significantly from those calculated in the model . In conclusion, poor performance status and lymphopenia identify a subgrou p of patients at high risk for early death after chemotherapy. (C) 2001 Can cer Research Campaign.