Chemotherapy-induced neutropenia

The major dose limiting toxicity of cancer chemotherapy.

Nearly one in three chemotherapy patients develop febrile or severe neutropenia according to a prospective registry of 2692 patients of all major tumor types (Crawford).

Predisposes to infection, especially if the neutrophil count is below 500 cells/µL.

Can result in fever, dose reductions and treatment delays.

In a retrospective analysis of 41,779 patients the mean inpatient mortality rate for febrile neutropenia related hospitalization was 9.5% overall (Kuderer).

Prophylactic use of colony-stimulating factors reduce severity and duration of febrile neutropenia.

Risks include advanced age, female gender, poor performance status, impaired nutritional status and chemotherapy dose intensity.

The risk of neutropenia is increased with factors such as kidney, heart and lung disease and the presence of diabetes which double the propensity for infection.

Predictors of neutropenic complications are advanced age, the presence of a hematologic neoplasm, the presence of greater tumor burden, high fever, the presence of hypotension on hospital admission, pneumonia, I.V. site infection and organ dysfunction.

Duration of hospitalization and inpatient mortality rate higher for patients with leukemia than for patients with solid malignancies.

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