From the Guidelines
Febrile neutropenia (FN) is diagnosed when a patient has a fever, typically defined as a rise in axillary temperature to >38.5°C, and an absolute neutrophil count (ANC) of <0.5 · 10^9/l 1.
Diagnostic Criteria and Risk Assessment
The diagnostic criteria for FN include:
- Fever, defined as a rise in axillary temperature to >38.5°C for a duration of >1 h 1
- ANC of <0.5 · 10^9/l 1 The risk assessment for FN is crucial in determining the type of empirical antibiotic therapy, venue of treatment, and duration of antibiotic therapy.
Risk Assessment
The risk assessment for FN can be done using:
- Clinical judgment criteria, which consider factors such as the duration of neutropenia, presence of co-morbid medical problems, and clinical instability 1
- MASCC scoring system, which assigns a score based on factors such as burden of febrile neutropenia, hypotension, chronic obstructive pulmonary disease, and age 1 Patients with a MASCC score <21 are considered high-risk, while those with a score ≥21 are considered low-risk 1.
High-Risk Patients
High-risk patients are those with:
- Anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/µL) 1
- Significant medical co-morbid conditions, such as hypotension, pneumonia, new-onset abdominal pain, or neurologic changes 1
- MASCC score <21 1 These patients should initially receive IV empirical antibiotic therapy in the hospital 1.
Low-Risk Patients
Low-risk patients are those with:
- Anticipated brief (<7 days) neutropenic periods 1
- Few co-morbidities 1
- MASCC score ≥21 1 These patients may be candidates for oral empirical therapy 1.
From the Research
Diagnostic Criteria of Febrile Neutropenia (FN)
- Febrile neutropenia (FN) is a medical emergency that can occur at any time during the course of a malignancy, especially hematologic malignancies, from diagnosis to end-stage disease 2
- Fever is often the sole sign of infection in patients with suppressed inflammatory responses 2
Risk Assessment of Febrile Neutropenia (FN)
- Risk stratification of febrile neutropenic patients can have important implications in terms of management 3
- A risk scoring system was developed in 1992 and subsequently updated in 2000, which predicts a <5% risk for severe complications with a score of < or =21 3
- Patients can be stratified into low-risk and high-risk groups based on their risk assessment scores 3, 4, 5
- High-risk criteria include profound neutropenia, short latency from a previous chemotherapy cycle, sepsis or clinically documented infection at presentation, severe co-morbidity, and a performance status greater than or equal to 3 6
Management of Febrile Neutropenia (FN)
- Oral combination therapy in an ambulatory or home care setting is acceptable for low-risk patients 3
- Hospital admission is mandatory for high-risk patients 3
- Intravenous monotherapy can be given if neutropenia is anticipated to be of short duration, or if the patient is stable and does not have an infectious focus 3
- Antimicrobial therapy with coverage against gram-negative organisms should always be provided due to the significant mortality associated with these infections 3, 5