Outcome of Febrile Neutropenic Patients on Granulocyte Colony Stimulating Factor in a Tertiary Care Hospital

Abstract

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge. Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June 2011. All adult patients who were admitted and treated with GCSF for chemotherapy induced febrile neutropenia were included. Multivariable regression was conducted to identify the factors related with poor outcomes. Results: A total of 131 patients with febrile neutropenia were identified with mean age of 43.2 (18-85) years, 79 (60%) being ≤50. Seventy-five (57%) had solid tumors and 56 (43%) hematological malignancies, including lymphoma. Fifty seven (43.5%) had an ANC less 100 cells/mm 3 , 34 (26%) one between100-300 cells/mm 3 and 40 (31%) an ANC greater than 300 cells/mm 3 . Thirty (23%) patients showed ANC recovery in 1-3 days, and 74(56%) within 4-7 days. Thirteen (10%) patients showed no recovery. The overall mortality was 18 (13.7%) patients. The mean time for ANC recovery seen in hematological malignancies was 6.34 days whereas for solid tumors it was 4.88 days. Patients with ANC <100 cells/mm 3 were more likely to die than patients with ANC >300 cells/mm 3 by a factor of 4.3. Similarly patients >50 years of age were 2.7 times more likely to die than younger patients. Conclusion: Our study demonstrated that use of GCSF, in addition to intravenous antibiotics, in treatment of patients with chemotherapy induced febrile neutropenia accelerates neutrophil recovery, and shortens antibiotic therapy and hospitalization. We propose to risk classify the patients at the time of admission to evaluate the cost effectiveness of this approach in a resource constrained setup.

Evaluation of prognostic factors in febrile neutropenic patients with hematological malignancies

“…In another study, Osmani et al found the mean ANS value to be 127/mm³ in the mor-tality group and reported a statistically significant relationship between ANS and mortality. 12 Our findings contradict those reported in the literature. We observed no statistically significant differ-ence in the median ANS values of the mortality and non-mortality groups (85/mm³ and 100/mm³, respectively).…”

Efficacy of Granulocyte Colony-Stimulating Factor in Established Neutropenia in Pediatric Solid Tumors

“…Patients with mild and moderate neutropenia had better outcome with no deaths reported among them compared to profound neutropenia. This is in agreement with Osmaniet al who recorded that patients with profound neutropenia were more likely to die than patients with severe and moderate neutropenia [12].…”

“…This is unlike what reported by Osmani et al where 43.5%, 26% and 31% of their patients presented by profound, severe and moderate neutropenia respectively. This difference may attributed to high percent of hematological malignancies among their patients which known by their aggressive chemotherapy and more bone marrow suppression more than solid tumors [12].…”

Burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia

“…The finding was supported by a previous observational study in Pakistan and India. 47 , 48 This might be because the use of filgrastim accelerates the production and circulating of neutrophils by reducing the transient time from stem cells to mature neutrophils. 49 In this study, the majority (95%) of the patients were treated with combined antibiotics and 30% of prescription was inappropriate.…”