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J Clin Oncol. 2015 Feb 10;33(5):465-71. doi: 10.1200/JCO.2014.57.2347. Epub 2015 Jan 5.

Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study.

Author information

1
Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile. alberto.carmonabayonas@gmail.com.
2
Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile.

Abstract

PURPOSE:

To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections.

PATIENTS AND METHODS:

We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE.

RESULTS:

We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC).

CONCLUSION:

CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.

PMID:
25559804
DOI:
10.1200/JCO.2014.57.2347
[Indexed for MEDLINE]

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