Antimicrobial Prophylaxis
Table 1. Factors to Consider in Assessing Risk of a Febrile
Neutropenic Episode in Patients Undergoing
Cytotoxic Chemotherapy for Malignancy
Factors
Related to: Factor Effect on Risk
Patient
characteristics
Advanced age Risk increases if ≥65 years
Performance
status
Risk increases if ECOG ≥2
Nutritional
status
Risk increases if albumin <35 g/L
Prior FN
episode
Risk in cycles 2–6 is 4-fold greater if FN episode
occurs in cycle 1
Comorbidities FN odds increase by 27%, 67%, and 125%,
respectively, for 1, 2 or ≥3 comorbidities
Underlying
malignancy
Cancer
diagnosis
Diagnosis
acute leukemia/MDS
high-grade lymphoma
so tissue sarcoma
NHL/myeloma
germ cell carcinoma
Hodgkin lymphoma
ovarian carcinoma
lung cancers
colorectal cancers
head & neck carcinoma
breast cancer
prostate cancer
Reported FN rates
85% to 95%
35% to 71%
27% (95% CI: 19–34.5%)
26% (95% CI: 22–29%)
23% (95% CI: 16.6–29%)
15% (95% CI: 6.6–24%)
12% (95% CI: 6.6–17.7%)
10% (95% CI: 9.8–10.7%)
5.5% (95% CI: 5.1–5.8%)
4.6% (95% CI: 1.0–8.2%)
4.4% (95% CI: 4.1–4.7%)
1% (95% CI: 0.9–1.1%)
Cancer stage Risk increases for advanced stage (≥2)
Remission
status
Risk increases if not in remission
Cancer
treatment
response
• Risk is lowest if patient has a CR
• If patient has a PR, FN risk is greater for acute
leukemia than for solid tissue malignancies
• FN risk is higher if persistent, refractory, or
progressive disease despite treatment
