From the Guidelines
Febrile neutropenia is characterized by fever, typically defined as a single oral temperature of ≥38.3°C or a temperature of ≥38.0°C sustained over one hour, in a patient with neutropenia, an abnormally low count of neutrophils, usually defined as an absolute neutrophil count below 500 cells/mm³ or expected to fall below this level within 48 hours. According to the most recent and highest quality study 1, fever can be an important indicator of infection in neutropenic patients, although clinicians should also be mindful that severely or profoundly neutropenic patients may present with suspected infection in an afebrile state or even hypothermic. Additional symptoms may include:
- Chills
- Rigors
- Fatigue
- Malaise
- Signs of infection at specific sites such as cough, sore throat, abdominal pain, diarrhea, dysuria, skin rashes, or inflammation Some patients may develop hypotension, tachycardia, and altered mental status if sepsis develops. It's essential to note that due to the lack of neutrophils, traditional inflammatory responses may be diminished, meaning that serious infections can present with minimal symptoms beyond fever.
The prevention and appropriate management of febrile neutropenia is crucial because the rate of major complications, such as hypotension, acute renal, respiratory, or heart failure, is approximately 25% to 30%, and mortality can be up to 11% 1. Febrile neutropenia is a medical emergency requiring immediate evaluation and treatment with broad-spectrum antibiotics, typically within one hour of presentation, as infections can progress rapidly in neutropenic patients, leading to sepsis and potentially death if not promptly addressed. The definition of febrile neutropenia may vary slightly across studies, with some defining it as a rise in axillary temperature to above 38.5°C for a duration of >1 h while having an absolute neutrophil count (ANC) of <0.5 · 109/l 1, but the core principle of prompt recognition and treatment remains the same.
From the FDA Drug Label
ZARXIO is a leukocyte growth factor indicated to • Decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with nonmyeloid malignancies receiving myelosuppressive anti‑cancer drugs associated with a significant incidence of severe neutropenia with fever (1. 1)
The symptoms of febrile neutropenia are not explicitly listed in the drug label, but it is mentioned that febrile neutropenia is characterized by infection and fever in patients with severe neutropenia 2.
- Fever is a key symptom of febrile neutropenia.
- Infection is also a manifestation of febrile neutropenia.
- Severe neutropenia is a condition characterized by a low neutrophil count, which can increase the risk of infection.
However, the exact symptoms of febrile neutropenia are not directly stated in the label.
From the Research
Symptoms of Febrile Neutropenia
The symptoms of febrile neutropenia include:
- Fever, defined as an oral temperature of >38.3°C or two consecutive readings of >38.0°C for 2 hours 3
- Low neutrophil count, defined as an absolute neutrophil count (ANC) of <0.5 × 10^9/l, or expected to fall below 0.5 × 10^9/l 3
- Infection, which can be caused by various microorganisms, including bacteria, fungi, or viruses 3, 4, 5, 6, 7
- Other symptoms may include:
Diagnosis and Treatment
Febrile neutropenia is typically diagnosed based on the presence of fever and low neutrophil count, and is often treated with broad-spectrum antibiotics 3, 4, 5, 6, 7. The treatment outcomes can be influenced by various factors, including: