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Elderly Vulnerable to Febrile Neutropenia Early in Chemotherapy

Elderly Vulnerable to Febrile Neutropenia Early in Chemotherapy

BOSTON—A review of more than 1,600 patients in the Oncology Practice
Pattern Study found a 50% higher risk of febrile neutropenia for elderly
patients than younger patients. Most incidents occurred during the first 21
days of chemotherapy, according to a presented at the third meeting of the
International Society of Geriatric Oncology (SIOG abstract P-22). Based on
the analysis, Vincent Caggiano, MD, medical director, Sutter Cancer Center,
Sacramento, and his colleagues urged oncologists to consider giving
prophylactic colony-stimulating factors (CSFs) during the first two
chemotherapy cycles—especially among older patients who are more vulnerable
to the complication.

"Age is the leading risk factor. We broke it at age 60, but if you go to
age 70 or more, the risk is even higher," he told ONI. "We conclude
that non-use of prophylactic CSFs is associated with an increased risk of
febrile neutropenia."

The investigators retrospectively examined the medical records of 704
patients with non-Hodgkin’s lymphoma (NHL) and 913 patients with early-stage
breast cancer. Of these, 211 patients (13%) had one or more hospitalizations
for febrile neutropenia. All received chemotherapy between 1991 and 1999 at
16 oncology practices; 60% were under age 60 (median age, 57).

For all patients, febrile neutropenia was most likely to occur during the
first two cycles, with the period of greatest hazard peaking midway through
cycle 1. Half of all first neutropenic hospitalizations occurred by day 21
and slightly more than two thirds by the end of the second cycle.

Patients age 60 and above were significantly more likely to experience
febrile neutropenia. They accounted for 61% of patients hospitalized with the
complication, but only 39% of those who did not have an episode. Other
significant risk factors were renal disease (9% of patients with febrile
neutropenia vs 1.3% of those without) or cardiovascular disease (18.5% vs
7.9%, respectively).

The investigators also reported increased risk of febrile neutropenia when
the planned average relative dose intensity exceeded 85% for early-stage
breast cancer patients or 80% for NHL patients. The latter were more likely
to be hospitalized for febrile neutropenia. NHL patients were only 44% of the
total sample but accounted for 70% of febrile neutropenic episodes.

Prophylactic use of CSFs was rare, he said. No early use of CSF was
recorded in 91% of patients with febrile neutropenia and in 92.1% of those
without.

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