Assessment
Table 1. Factors to Consider in Assessing Risk of an FNE 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
(PS)
Risk increases if Eastern Cooperative Oncolog y Group
(ECOG) PS ≥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
(highest to lowest risk)
Diagnosis
Acute leukemia/MDS
So tissue sarcoma
NHL/myeloma
Germ cell carcinoma
Hodgkin's lymphoma
Ovarian carcinoma
Lung cancers
Colorectal cancers
Head & neck carcinoma
Breast cancer
Prostate cancer
Reported FN rates
85% to 95%
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%)
1.0% (95% CI: 0.9%-1.1%)
Cancer stage Risk increases for advanced stage (≥2)
Remission status Risk increases if not in remission
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
Treatment for
malignancy
Cytotoxic regimen Risk is higher with regimens that administer:
• anthracyclines at doses ≥90 mg/m
2
• cisplatin at doses ≥100 mg/m
2
• ifosfamide at doses ≥9 g/m
2
• cyclophosphamide at doses ≥1 g/m
2
• etoposide at doses ≥500 mg/m
2
• cytarabine at doses ≥1 g/m
2
• high dose-density, eg, CHOP-14
• anthracycline + taxane ± cyclophosphamide, or
anthracycline + gemcitabine, for breast cancer
Dose intensity Increased risk if >85% of scheduled doses are administered
a
Degree & duration of
oral &/or GI mucositis
Risk is greatest if NCI mucositis grade is ≥3 (GI) or if
peak OMAS score is ≥2
Degree & duration of: Neutropenia: ANC <500/µL for ≥7 days
Lymphopenia: ALC <700/µL (ANC surrogate)
Monocytopenia: AMC <150/µL (ANC surrogate)
Prophylactic use of
WBC growth factors
Reduces risk for patients selected as in ASCO guideline
a
Routine decreases in dose intensity as a means of preventing FN are NOT recommended.
