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Predicting Risk Of Neutropenic Complications: A Point-Of-Care Assessment Tool

Heather Jones, MD

University of Pennsylvania Cancer
Ultima Vez Modificado: 13 de mayo del 2001

Presenter: Lloyd Lininger
Affiliation: SUNY Albany, Albany, NY

Background:

Neutropenia induced by chemotherapy (CT) is associated with increased morbidity and decreased quality-of-life. Dose reductions and delays due to severe neutropenia may also compromise long- term survival. Prophylactic use of G-CSF has been shown to be effective in preventing these negative outcomes. This study evaluates a tool that is designed to predict risk of neutropenic complications in individual patients at CT outset in an effort to aid physicians to cost- effectively employ G-CSF in those most likely to benefit. This study endeavors to identify risk factors independently associated with neutropenic complications for eventual incorporation into a point-of-care predictive tool.

Materials and Methods:

• Retrospective review of 229 patients given adjuvant CT for early breast cancer.
• Electronic medical records were provided by iKnowMed for review.
• Primary endpoints of the study were CSF use, severe neutropenia (ANC <500/uL) and CT dose delays and reductions.
• Multivariate logistic regression analysis was performed to identify risk factors that independently predict for the occurrence of receiving < 85% of the planned dose intensity of CT and for severe neutropenia.

Results:

• The 229 patients had a total of 1277 cycles of CT; most (95%) completing 4 to 8 cycles.
• 16% of the patients were greater than 65 years. Most had early stage cancer (91% had stage I or II disease with 57% being node negative).
• Almost half the patients (47%) received < 85% of the planned dose intensity of CT. One in five (19%) experienced severe neutropenia and approximately one in four 24% was given CSF.
• CSF use was associated with a greater proportion of patients receiving < 85% of planned dose intensity; 66% with CSF vs old 47% without (p < 0.0001).
• Doxorubicin-containing regimens were associated with a lower risk of receiving < 85% of planned dose intensity of CT.
• Patients who received CSF had a higher rate of severe neutropenia than those who did not receive CSF 26% vs 17%.
• Logistic regression shows that the variables consisting of baseline WBC, estrogen receptor status, treatment regimen, and whether the patient received CSF were predictive for severe neutropenia. Baseline ANC count was predictive for the patient receiving CSF.

Authors' Conclusions

• By reducing the risk of neutropenic complications, prophylactic G-CSF increased the chances that chemotherapy will be delivered as planned. In this study,
• G-CSF use was associated with a greater proportion of patients achieving > 85% of planned dose intensity of CT.
• Patients who received G-CSF had a higher rate of severe neutropenia than those who did not receive, possibly reflecting the use of CSF in patients at higher risk for myelotoxicity.
• Logistic regression defined low ANC and ER status as independent predictors of receiving < 85% of planned dose intensity of CT. While, Doxorubicin in the regimen was independent predictor for < 85% of planned dose intensity of CT.

Clinical/Scientific Implications:

Dose reduction and delays in chemotherapy are often used to manage chemotherapy-induced neutropenia. Studies indicate that such reductions may result in a decrease in treatment effectiveness and long-term survival. A practical risk assessment tool can be used to identify patients at risk for developing neutropenic complications. Such a tool would help select the patients who would most benefit from prophylactic G-CSF. This is an exciting initial step in the development of such a tool.