Thungthong Pravinwan, Chamnanchanunt Supat, Suwanban Tawatchai, Nakhahes Chajchawan, Iam-Arunthai Kunapa, Akrawikrai Tananchai, Bunworasate Udomsak, Rojnuckarin Ponlapat
Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Front Med (Lausanne). 2023 Mar 13;10:1122282. doi: 10.3389/fmed.2023.1122282. eCollection 2023.
A tool for estimating risk of febrile neutropenia (FN) after chemotherapy, namely the FEbrile Neutropenia after ChEmotherapy (FENCE) score, has been developed but has not been widely validated. This study aimed to validate the FENCE score as a tool for predicting granulocyte colony-stimulating factor (G-CSF) breakthrough FN among patients with lymphoma who underwent chemotherapy.
This was a prospective observational study of treatment-naive adult patients with lymphoma who underwent their first cycle of chemotherapy between 2020 and 2021. The patients were followed up until the next cycle of chemotherapy to identify any infection events.
Among the 135 patients with lymphoma, 62 (50%) were men. In a comparison of the value of each FENCE parameter for predicting G-CSF breakthrough infection, the parameter of advanced-stage disease showed high sensitivity of 92.8%, and receipt of platinum chemotherapy showed high specificity of 95.33%. With a FENCE score of 12 as a cutoff for low risk, analysis across all patients with lymphoma resulted in a high AUROCC of 0.63 (95% CI = 0.5-0.74%; = 0.059), and analysis across only patients with diffuse large B-cell lymphoma (DLBCL) resulted in an AUROCC of 0.65 (95% CI = 0.51-0.79%; = 0.046). With a cutoff point of 12, FENCE score can predict breakthrough infection events at 30.0% (95% CI = 17.8-47.4%).
This study divided patients with lymphoma into risk groups according to FENCE score, showing that this instrument has discriminatory ability in predicting FN events, these being more likely to occur in patients in the intermediate- and high-risk groups. Multicenter studies are needed to validate this clinical risk score.
一种用于评估化疗后发热性中性粒细胞减少症（FN）风险的工具，即化疗后发热性中性粒细胞减少症（FENCE）评分已被开发出来，但尚未得到广泛验证。本研究旨在验证FENCE评分作为预测接受化疗的淋巴瘤患者中粒细胞集落刺激因子（G-CSF）突破性FN的工具。
这是一项对2020年至2021年间接受首个化疗周期的初治成年淋巴瘤患者的前瞻性观察性研究。对患者进行随访直至下一个化疗周期，以确定任何感染事件。
在135例淋巴瘤患者中，62例（50%）为男性。在比较每个FENCE参数预测G-CSF突破性感染的价值时，晚期疾病参数显示出92.8%的高敏感性，接受铂类化疗显示出95.33%的高特异性。以FENCE评分为12作为低风险的临界值，对所有淋巴瘤患者进行分析得出的曲线下面积（AUROCC）为0.63（95%可信区间=0.5-0.74%；P=0.059），仅对弥漫性大B细胞淋巴瘤（DLBCL）患者进行分析得出的AUROCC为0.65（95%可信区间=0.51-0.79%；P=0.046）。以12为临界值时，FENCE评分可预测30.0%（95%可信区间=17.8-47.4%）的突破性感染事件。
本研究根据FENCE评分将淋巴瘤患者分为风险组，表明该工具在预测FN事件方面具有鉴别能力，这些事件更有可能发生在中高风险组的患者中。需要进行多中心研究来验证这一临床风险评分。
