Division of Haematology/Oncology; Child Health Evaluative Sciences, The Hospital for Sick Children.
Child Health Evaluative Sciences, The Hospital for Sick Children.
Ann Oncol. 2011 Nov;22(11):2358-2365. doi: 10.1093/annonc/mdq745. Epub 2011 Mar 1.
In some centers, outpatient management for cancer patients with low-risk febrile neutropenia (FN) has been implemented into routine clinical practice. Our objective was to evaluate the current level of evidence before supporting widespread adoption of outpatient management for this population.
We systematically reviewed randomized controlled trials evaluating efficacy and safety of outpatient management of FN.
From 1448 reviewed articles, 14 studies were included for meta-analysis. (i) Inpatient versus outpatient setting (6 studies) was not significantly associated with treatment failure [risk ratio 0.81; 95% confidence interval (CI) 0.55-1.19; P = 0.28]. Death occurred in 13 of 742 FN episodes with no difference between the two groups (risk ratio 1.11; 95% CI 0.41-3.05; P = 0.83). (ii) Outpatient oral versus outpatient parenteral antibiotics (8 studies) were similarly efficacious with no association between route of drug administration and treatment failure (risk ratio 0.93; 95% CI 0.65-1.32; P = 0.67). No death occurred in 857 FN episodes.
Based on the current literature, outpatient treatment of FN is a safe and efficacious alternative to inpatient management. Variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.
在一些中心，已经将低危发热性中性粒细胞减少症（FN）患者的门诊管理纳入常规临床实践。我们的目的是在支持广泛采用这种人群的门诊管理之前，评估当前证据的水平。
我们系统地回顾了评估 FN 门诊管理的疗效和安全性的随机对照试验。
从 1448 篇综述文章中，有 14 项研究纳入荟萃分析。（i）住院与门诊环境（6 项研究）与治疗失败无显著相关性[风险比 0.81；95%置信区间（CI）0.55-1.19；P=0.28]。两组 FN 发作中死亡的发生率均为 13/742 例，无差异（风险比 1.11；95% CI 0.41-3.05；P=0.83）。（ii）门诊口服与门诊静脉用抗生素（8 项研究）同样有效，药物给药途径与治疗失败之间无关联（风险比 0.93；95% CI 0.65-1.32；P=0.67）。857 例 FN 发作中未发生死亡。
根据目前的文献，FN 的门诊治疗是一种安全有效的住院管理替代方法。研究之间在出院时间、抗生素类别选择和研究人群年龄方面的差异可能限制了对数据的解释。
