LOW-RISK FEBRILE NEUTROPENIA IN A MEDICAL ONCOLOGY UNIT

Background: Febrile neutropenia occurring in patients receiving chemot herapy for solid rumours or lymphoma is usually of short duration, and therefore may have a better outcome compared to patients with acute l eukaemia or patients receiving myeloablative chemotherapy. Aims: To re view retrospectively the outcomes for febrile neutropenia occurring in patients of the Medical Oncology Unit at our institution, and to iden tify factors associated with worse outcome, particularly prolonged adm ission or death. Methods: We reviewed 102 episodes of febrile neutrope nia occurring in 85 patients treated between 1992 and 1994. Demographi c factors, tumour-related factors and clinical aspects of the episodes were correlated with outcome. Results: The median age was 60 years (r ange, 18-87), with 56 (55%) episodes occurring in females. Twenty-eigh t (27%) episodes occurred in patients with lymphoma, with the remainin g 74 (73%) occurring in patients with solid tumours. At presentation, the median absolute neutrophil count (ANC) was 0.14 X 10(9)/L with a m edian duration of significant neutropenia (ANC<0.5 X 10(9)/L) of three days. The median duration of fever was two days. Twenty-nine (28%) ep isodes had positive cultures; of these 11 had bacteraemia. Forty-four (43%) episodes were classified as unexplained fevers. The remaining 29 episodes were associated with clinically documented infection but neg ative cultures. There was a high treatment success rate (81%) with fir st-line empirical antibiotics. Of 19 treatment failures, 13 were due t o the necessity for antibiotic modification; the: other six patients d ied from infection. Factors associated with a worse outcome (including prolonged admission and death) include: diagnosis of lymphoma; increa sing number of chemotherapy courses; early onset of neutropenia; pneum onia; severe hypotension; and multiple co-morbidities. Conclusions: Fe brile neutropenia in adult patients with solid tumours or lymphoma is associated with a relatively good outcome, possibly due to the short d uration of neutropenia. A future prospective study to validate the ris k factors indentified in this study would be useful for defining patie nts at low risk for the adverse outcomes examined, in whom less intens ive management for this condition may be possible.