Key Points
➤ Prophylactic use of colony-stimulating factors (CSFs) to reduce the
risk of febrile neutropenia is warranted when the risk of febrile
neutropenia is approximately 20% or higher and no other equally
effective and safe regimen that does not require CSFs is available.
➤ Primary prophylaxis is recommended for the prevention of febrile
neutropenia in patients who are at high risk on the basis of age,
medical history, disease characteristics, and myelotoxicity of the
chemotherapy regimen.
➤ Dose-dense regimens that require CSFs should be used only within
an appropriately designed clinical trial or if supported by convincing
efficacy data.
➤ Current recommendations for the management of patients exposed to
lethal doses of total-body radiotherapy, but not doses high enough to
lead to certain death as a result of injury to other organs, include the
prompt administration of CSFs.
Diagnosis
Table 1. Patient Risk Factors for Febrile Neutropenia
In addition to chemotherapy regimen and type of malignancy, consider the following
factors when estimating patient's overall risk of febrile neutropenia.
• Age ≥65 years • Poor performance status or poor nutritional status
• Advanced disease • Poor renal function
• Previous chemotherapy or
radiation therapy
• Liver dysfunction, most notably elevated bilirubin
• Preexisting neutropenia or bone
marrow involvement with tumor
• Infection
• Cardiovascular disease
• Multiple comorbid conditions
• Open wounds or recent surgery
• HIV infection