Background: Febrile neutropenia (FN) is one of the most serious complications in patients with hematological malignancies. Several risk assessment guidelines have been adopted to identify patients as low and high risk of complications. Aim: To identify specific factors that may affect the response to antibiotics and antifungal therapy in patients with febrile neutropenia. Patients and methods: During the period of 1st of April 2014 until the end of January 2015, patients with hematological malignancies who presented to clinical oncology department and developed FN during management were enrolled in this prospective analysis . At the onset of fever, patients underwent complete physical examination. In addition to blood culture. Computer tomography of the chest and paranasal sinuses and serial galactomannan (GM) test were requested in cases with uncontrolled fever or suspected invasive fungal infection (IFI).Polymerase chain reaction analysis of bacteria and fungi from the blood and bronchoalveolar lavage were performed in selected cases. Results: 135 patients were identified . The mean age was 38.5 years , 51% had acute myeloid leukemia, 36% acute lymphoblastic leukemia , non hodgkin's lymphoma , chronic lymphocytic leukemia , and multiple myeloma were diagnosed in 7% , 4%, and 2% respectively .According to Multinational Association for Supportive Care in Cancer (MASCC) index , 80 patients (60%) were categorized as high MASCC score (<21), while 55 patients (40%) had low MASCC score (>21) . Blood culture was negative in 114 (84%), while it was positive in 21 cases (16%). The choice between first line antibiotics (ceftazidime, cefipime, imipenem) or antifungal (amphotericin, voriconazole) had no impact on the recurrence of FN attacks (P<0.08 and p<0.23 respectively). In terms of fever control on first line antibiotics , there was statistically significant difference in favor of low risk MASCC score (p<0.001). With respect to first antifungal used, a significant correlation was observed between low/high MASCC score and control on first antifungal therapy (P=0.001)..Prolonged FN (>7days) was observed in 40 % of cases ,the use of corticosteroids , and non administration of granulocyte colony stimulating factor (G-CSF) were the predominant risk factors (P<0.001 ,P<0.002 respectively). In terms of mortality, only patients with high MASCC score (n=11) (8%) had the worst outcome compared to low score (n=1) (P<0.0001).Summary/Conclusion: There are multiple factors that may affect the outcome of patients with FN and it should be taken in considerations during management of FN such as MASCC score, detection of the organism, previous use of corticosteroid and G-CSF administration during FN.
Febrile neutropenia, Malignancies, Oncology, Galactomannan