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Outcome of Febrile Neutropenic Patients on Granulocyte Colony Stimulating Factor in a Tertiary Care Hospital

  • Osmani, Asif Husain (Section Hematology/Oncology, Department of Medicine, Aga Khan University Hospital) ;
  • Ansari, Tayyaba Zehra (Section Hematology/Oncology, Department of Medicine, Aga Khan University Hospital) ;
  • Masood, Nehal (Section Hematology/Oncology, Department of Medicine, Aga Khan University Hospital) ;
  • Ahmed, Bilal (Section Hematology/Oncology, Department of Medicine, Aga Khan University Hospital)
  • Published : 2012.06.30

Abstract

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge. Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June 2011. All adult patients who were admitted and treated with GCSF for chemotherapy induced febrile neutropenia were included. Multivariable regression was conducted to identify the factors related with poor outcomes. Results: A total of 131 patients with febrile neutropenia were identified with mean age of 43.2 (18-85) years, 79 (60%) being ${\leq}50$. Seventy-five (57%) had solid tumors and 56 (43%) hematological malignancies, including lymphoma. Fifty seven (43.5%) had an ANC less 100 cells/$mm^3$, 34 (26%) one between 100-300 cells/$mm^3$ and 40 (31%) an ANC greater than 300 cells/$mm^3$. Thirty (23%) patients showed ANC recovery in 1-3 days, and 74(56%) within 4-7 days. Thirteen (10%) patients showed no recovery. The overall mortality was 18 (13.7%) patients. The mean time for ANC recovery seen in hematological malignancies was 6.34 days whereas for solid tumors it was 4.88 days. Patients with ANC <100 cells/$mm^3$ were more likely to die than patients with ANC >300 cells/$mm^3$ by a factor of 4.3. Similarly patients >50 years of age were 2.7 times more likely to die than younger patients. Conclusion: Our study demonstrated that use of GCSF, in addition to intravenous antibiotics, in treatment of patients with chemotherapy induced febrile neutropenia accelerates neutrophil recovery, and shortens antibiotic therapy and hospitalization. We propose to risk classify the patients at the time of admission to evaluate the cost effectiveness of this approach in a resource constrained setup.

Keywords

Febrile neutropenia;GCSF;absolute neutrophil count (ANC);recovery time

References

  1. Berghmans T, Paesmans M, Lafitte JJ, et al (2002). Therapeutic use of granulocyte and granulocyte-macrophages colony stimulating factors in febrile neutropenic cancer patients. Support Care Cancer, 10, 181-8. https://doi.org/10.1007/s00520-001-0312-5
  2. CaggianoV, Weiss RV, Rickert TS, et al (2005). Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer, 103, 1916-24. https://doi.org/10.1002/cncr.20983
  3. Carbonero RG, Mayordomo JI, Tornamira MV, et al (2001). Granulocyte colony stimulating factor in the treatment of High risk febrile neutropenia: A multicenter randomized trial. J Natl Cancer Inst, 93, 31-8. https://doi.org/10.1093/jnci/93.1.31
  4. Carmonera-Bayonas A, Gomez J, Gonzalez-Billalabeitia E, et al (2011). Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. BJC, 105, 612-17. https://doi.org/10.1038/bjc.2011.284
  5. Clark DAC, Lyman GH, Castro AA, et al (2005). Colony stimulating factors for chemotherapy induced febrile neutropenia: A Meta analysis of randomized controlled trials. J Clin Oncol, 23, 4198-214. https://doi.org/10.1200/JCO.2005.05.645
  6. Cosler LE, Eldar-Lissai A, Culakova E, et al (2007). Therapeutic use of granulocyte colony-stimulating factors for established febrile neutropenia: effect on costs from a hospital perspective. Pharmacoeconomics, 25, 343-51. https://doi.org/10.2165/00019053-200725040-00006
  7. Crawford J, Ozer H, Stoller R, et al (1991). Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with smallcell lung cancer. N Engl J Med, 325, 164-70. https://doi.org/10.1056/NEJM199107183250305
  8. Ghalaut PS, Sen R, Dixit G (2008). Role of granulocyte colony stimulating factors (G-CSF) in chemotherapy induced neutropenia. JAPI, 56, 942-44.
  9. Kuderer NM, Dale DC, Crawford J, et al (2006). Mortality, morbidity and cost associated with febrile neutropenia in adult cancer patients. Cancer, 106, 2258-66. https://doi.org/10.1002/cncr.21847
  10. Kuderer NM, Dale DC, Crawford J, Lyman GH (2007). Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol, 25, 3158-67. https://doi.org/10.1200/JCO.2006.08.8823
  11. Lal A, Bhurgri Y, Rizvi N, et al (2008). Factors influencing in-hospital length of stay and mortality in cancer patients suffering from febrile neutropenia. Asian Pac J Canc Prev, 9, 303-8.
  12. Maher DW, Lieschke GJ, Green M, et al (1994). Filgastrim in patients with chemotherapy-induced febrile neutropenia. A double-blind, placebo-controlled trial. Ann Intern Med, 121, 492-501. https://doi.org/10.7326/0003-4819-121-7-199410010-00004
  13. Mayordomo JI, Rivera F, Diaz-Puente MT, et al (1995). Improving treatment of chemotherapy-induced neutropenic fever by administration of colony-stimulating factors. J Natl Cancer Inst, 87, 803-15. https://doi.org/10.1093/jnci/87.11.803
  14. Metcalf D (1990). The colony stimulating factors. Discovery, development, and clinical applications. Cancer, 6, 2185-95.
  15. Oguz A, Karadeniz C, Ckitak EC, et al (2006). Which one is a risk factor for chemotherapy-induced febrile neutropenia in childhood solid tumors: early lymphopenia or monocytopenia. Pediatr Hematol Oncol, 23, 143-51. https://doi.org/10.1080/08880010500457673
  16. Pettengell R, Johnson HE, Lugtenburg PJ, et al (2012). Impact of febrile neutropenia on R-CHOP chemotherapy delivery and hospitalizations among patients with diffuse large B-cell lymphoma. Support Canc Care, 20, 647-52. https://doi.org/10.1007/s00520-011-1306-6
  17. Rankoff WR, Gonin R, Robinson C, et al (1996). Predicting the risk of bacteremia in children with fever and neutropenia. J Clin Oncol, 14, 919-24.
  18. Riikonen P, Saarinen UM, Makipernaa A, et al (1994). Recombinant human granulocte-macrophage colony stimulating factor in the treatment of febrile neutropenia: a double-blind, placebo-controlled study in children. Pediatr Infect Dis J, 13, 197-202. https://doi.org/10.1097/00006454-199403000-00006
  19. Shaikh AJ, Bawany SA, Masood N, et al (2011). Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia. J Cancer, 2, 62-6.
  20. Souza LM, Boone TC, Gabrilove J, et al (1986). Recombinant human granulocyte colony-stimulating factor: effects on normal and leukemic myeloid cells. Science, 232, 61-5. https://doi.org/10.1126/science.2420009

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