History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs

Abstract

Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital. Patients and methods: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France). Results: Mean patient age was 52.2 years old (range: 18–93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0–0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2–21), which was reduced to 0.7 days (range: 2–16) (p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died. Conclusions: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of “daily medication” exposure.

Causes and outcomes of non-chemotherapy induced neutropenic fever in hospitalized adults: An observational study

“…[ 18 ] The extensive list of non-chemotherapy medications causing neutropenia identified in this study are compatible with findings of other observational studies. [ 4 , 18 , 19 ] Surprisingly, the only medication pinpointed as a cause of fever in our study was anti-thymocyte globulin, but prior studies describe fever related to drugs as relatively common. [ 20 ] The only illicit drug implicated in causing neutropenia in our study was heroin.…”

“…[ 2 ] Multiple clinical practice guidelines and risk calculators address chemotherapy induced neutropenic fever (CINF). [ 1 , 3 , 4 ] However, neutropenia can also be caused by non-chemotherapy drugs, infections, autoimmune conditions, and malignancies in the absence of chemotherapy. [ 1 ] While much is known about CINF, there is a paucity of data on the frequency, causes, and outcomes of non-chemotherapy induced neutropenic fever (non-CINF).…”

“…[ 1 ] While much is known about CINF, there is a paucity of data on the frequency, causes, and outcomes of non-chemotherapy induced neutropenic fever (non-CINF). [ 4 ] To address this knowledge gap, we sought to characterize the frequency, causes and outcomes of non-CINF in a sample of hospitalized adults.…”

Profil Pasien Demam Neutropenia Tidak Terkait Kemoterapi di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo

“…Demam neutropenia merupakan kondisi kegawatdaruratan yang mencapai 90-100%. 1,2 Kejadian demam neutropenia umumnya dilaporkan pada pasien pasca pajanan terhadap obat kemoterapi kanker 10-50% pada tumor padat dan dilaporkan pada ≥80% pada keganasan hematologi. 3 Selain kemoterapi, demam pada neutropenia dapat pula terjadi pada neutropenia yang disebabkan etiologi lainnya.…”