Cherif Honar, Johansson Eva, Björkholm Magnus, Kalin Mats
Division of Hematology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
Haematologica. 2006 Feb;91(2):215-22.
It is now evident that patients experiencing febrile neutropenia induced by chemotherapy do not constitute a homogeneous group. With increasing accuracy it is now possible to identify low-risk patients for whom less intensive and more convenient treatment may be appropriate.
In a cohort of such patients with hematologic malignancies, we prospectively validated the usefulness of the risk-index of the Multinational Association of Supportive Care in Cancer (MASCC) in identifying patients at low risk for the development of serious medical complications. Moreover, we studied the feasibility and safety of early discharge of these low-risk patients 24 hours after fever defervescence with subsequent oral antibiotic therapy.
Of the 279 episodes of febrile neutropenia included, 105 (38%) had a MASCC risk-index score indicating low risk. Serious complications were reported in connection with 111 (63%) high-risk and 16 (15%) low-risk episodes (p<0.0001). The risk-index identified low-risk patients with a specificity, sensitivity and positive predictive value of 87%, 58%, and 84%, respectively. A substantial proportion of the low-risk patients (36%) were considered ineligible for oral therapy, while the remaining 67 (64%) received oral antibiotic treatment following discharge from the hospital 24 hours after defervescence. Upon final evaluation, 64 of the discharged patients (95%) remained afebrile, only three required readmission and there was no mortality in this group.
The MASCC risk-index is a valuable tool for identifying febrile neutropenic patients at low risk for complications. Oral antibiotic treatment following discharge from the hospital 24 hours after defervescence offers a safe and cost-effective alternative to the conventional management of carefully selected low-risk patients.
目前已明确，化疗所致发热性中性粒细胞减少症患者并非一个同质化群体。随着准确性的提高，现在能够识别出低风险患者，对其采用强度较低且更便捷的治疗或许是合适的。
在一组此类血液系统恶性肿瘤患者中，我们前瞻性地验证了癌症支持治疗多国协会（MASCC）风险指数在识别发生严重医学并发症低风险患者方面的有效性。此外，我们研究了这些低风险患者在热退24小时后提前出院并随后接受口服抗生素治疗的可行性和安全性。
在纳入的279例发热性中性粒细胞减少症发作中，105例（38%）的MASCC风险指数评分表明为低风险。111例（63%）高风险发作和16例（15%）低风险发作报告了严重并发症（p<0.0001）。该风险指数识别低风险患者的特异性、敏感性和阳性预测值分别为87%、58%和84%。相当一部分低风险患者（36%）被认为不适合口服治疗，而其余67例（64%）在热退24小时后出院后接受了口服抗生素治疗。最终评估时，64例出院患者（95%）仍未发热，仅3例需要再次入院，且该组无死亡病例。
MASCC风险指数是识别并发症低风险发热性中性粒细胞减少症患者的一项有价值工具。热退24小时后出院并接受口服抗生素治疗为精心挑选的低风险患者的传统管理提供了一种安全且具成本效益的替代方案。
