ASSOCIATION OF FEBRILE NEUTROPENIA WITH CHEMOTHERAPEUTIC AGENTS IN MALIGNANCIES

Byomakesh Swain; Harpreet Singh; Ravi Jain; SANDEEP Mishra

doi:10.22159/ajpcr.2023.v16i8.48926

Authors

Byomakesh Swain Department of Medicine, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India. https://orcid.org/0009-0002-9427-627X
Harpreet Singh Department of Radiology, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India. https://orcid.org/0009-0002-4626-4602
Ravi Jain Department of Medicine, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India.
SANDEEP Mishra Agartala Government Medical College, Agartala, Tripura, India. *

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i8.48926

Keywords:

Febrile neutropenia, Malignancy, Microbes, Chemotherapy, Colony-stimulating factors

Abstract

Objective: Chemotherapy-induced febrile neutropenia (FN) is associated with substantial morbidity, mortality, and healthcare costs. The aim of this study was to evaluate episodes of FN in patients with malignancies, to find out the association of FN with various chemotherapeutic regimens, and to identify the microorganisms and the factors affecting the outcome.

Methods: All patients with FN were admitted and detailed history was taken with thorough clinical evaluation. Blood, urine, and throat swab cultures and cultures from any other clinically evident site of infection were sent to all the patients.

Results: Most common diagnosis was Ca breast and non-Hodgkin’s lymphoma in 13 patients. The ECOG performance status of 2 was seen in 61% of patients. The FN episodes (11%) were associated with carboplatin plus paclitaxel, and in patients with Ca cervix, Ca esophagus, and Ca ovary. The chest was involved in 16% of patients followed by the GI tract in 10%. Pseudomonas aeruginosa organism growth was seen in a 50% sample of throat swabs. The mean number of days of chemotherapy, after which patients reported to have FN, was 3.6, and median (interquartile range [IQR]) days was 2. Granulocyte colony-stimulating factor was administered in all patients in this study. The mean number of days of recovery of the patients was 4.9 and median (IQR) days was 4.

Conclusion: The episodes of FN occurred mostly in patients with Ca breast, followed by non-Hodgkin’s lymphoma. FN was more commonly seen with taxanes.

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Author Biographies

Byomakesh Swain, Department of Medicine, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India.

Assistant Professor, Dept. of Medicine

Harpreet Singh, Department of Radiology, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India.

Assistant professor, Dept. of Radiology

Ravi Jain, Department of Medicine, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab, India.

Assistant Professor, Dept. of Medicine

SANDEEP Mishra, Agartala Government Medical College, Agartala, Tripura, India. *

Chief Medical Officer

References

Bennett CL, Djulbegovic B, Norris LB, Armitage JO. Colony-stimulating factors for febrile neutropenia during cancer therapy. N Engl J Med 2013;368:1131-9.

Klastersky J, Debusscher L, Weerts D, Daneau D. Use of oral antibiotics in protected units environment: Clinical effectiveness and role in the emergence of antibiotic-resistant strains. Pathol Biol (Paris) 1974;22:5-12.

Lyman GH, Delgado DJ. Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOPR, or CNOP chemotherapy for intermediate-grade non- Hodgkin lymphoma. Cancer 2003;98:2402-9.

Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993;328:1323-32.

Barron RL. Pathophysiology of septic shock and implications for therapy. Clin Pharm 1993;12:829-45.

Elting LS, Rubenstein EB, Rolston KV, Bodey GP. Outcomes of bacteremia in patients with cancer and neutropenia: Observations from 2 decades of epidemiological and clinical trials. Clin Infect Dis 1997;25:247-59.

Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: A systematic review. J Clin Oncol 2007;25:3158-67.

The EORTC International Antimicrobial Therapy Project Group. Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Infect Dis 1978;137:14-29.

Talcott JA, Siegel RD, Finberg R, Goldman L. Risk assessment in cancer patients with fever and neutropenia: A prospective, two center validation of a prediction rule. J Clin Oncol 1992;10:31622.

EORTC International Antimicrobial Therapy Project Group. Trimethoprimsulfamethoxazole in the prevention of infection in neutropenic patients. EORTC International Antimicrobial Therapy Project Group. J Infect Dis 1984;150:3729.

Gafter-Gvili A, Paul M, Fraser A, Leibovici L. Effect of quinolone prophylaxis in afebrile neutropenic patients on microbial resistance: Systematic review and metaanalysis. J Antimicrob Chemother 2007;59:5-22.

Talcott JA, Whalen A, Clark J, Rieker PP, Finberg R. Home antibiotic therapy for lowrisk cancer patients with fever and neutropenia: A pilot study of 30 patients based on a validated prediction rule. J Clin Oncol 1994;12:10714.

Haupt R, Romanengo M, Fears T, Viscoli C, Castagnola E. Incidence of septicaemias and invasive mycoses in children undergoing treatment for solid tumours: A 12-year experience at a single Italian institution. Eur J Cancer 2001;37:2413-9.

Gaytan-Martınez J, Mateos-Garcia E, Sanchez-Cortes E, Gonzalez- Llaven J, Casanova-Cardiel LJ, Fuentes-Allen JL. Microbiological findings in febrile neutropenia. Arch Med Res 2000;31:388-92.

Siddaiahgari S, Manikyam A, Kumar KA, Rauthan A, Ayyar R. Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center. Indian J Cancer 2014;51:403-5.

Ahn S, Lee YS, Chun YH, Kwon IH. Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia. Support Care Cancer 2011;19:1151-8.

Bronchud MH, Scarffe JH, Thatcher N, Crowther D, Souza LM, Alton NK, et al. Phase I/II study of recombinant human granulocyte colony-stimulating factor in patients receiving intensive chemotherapy for small cell lung cancer. Br J Cancer 1987;56:809-13.

Gabrilove JL, Jakubowski A, Scher H, Sternberg C, Wong G, Grous J, et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional-cell carcinoma of the urothelium. N Engl J Med 1988;318:1414-22.

Morstyn G, Campbell L, Souza LM, Alton NK, Keech J, Green M, et al. Effect of granulocyte colony stimulating factor on neutropenia induced by cytotoxic chemotherapy. Lancet 1988;1:667-72.

European Medicines Agency. EPAR Summary for the Public: Biograstim. European Medicines Agency; 2008. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/biograstim [Last accessed on 2008 Sep 29].

Roviello G, Ramello M, Catalano M, D’Angelo A, Conca R, Gasperoni S, et al. Association between neutropenia and survival to nab-paclitaxel and gemcitabine in patients with metastatic pancreatic cancer. Sci Rep 2020;10:19281.

Sato Y, Yamamoto N, Kunitoh H, Ohe Y, Minami H, Laird NM, et al. Genome-wide association study on overall survival of advanced non-small cell lung cancer patients treated with carboplatin and paclitaxel. J Thorac Oncol 2011;6:132-8.

Hashiguchi Y, Kasai M, Fukuda T, Ichimura T, Yasui T, Sumi T. Chemotherapy-induced neutropenia and febrile neutropenia in patients with gynecologic malignancy. Anticancer Drugs 2015;26:1054-60.