Nur SOYER, ASU FERGÜN YILMAZ, MURAT TOMBULOĞLU, Ahmet DİRİCAN, SABİRE ŞÖHRET AYDEMİR, Seçkin ÇAĞIRAGAN, Ayhan DÖNMEZ

Risk factors for febrile neutropenic attacks in patients who were given chemotherapy treatment for hematological malignancies

Amaç: Febril nötropenik ataklar kemoterapi sırasında ve sonrasında önemli bir problemdir. Biz febril nötropenik atak için risk faktörlerini saptamak için kemoterapi alan hastaların kayıtlarını geriye dönük olarak inceledik. Gereç ve Yöntem: Toplam 154 (92 erkek ve 62 kadın) hastanın 2004-2006 yılları arasındaki 261 yatış periyodu geriye dönük olarak analiz edildi. Ortanca yaş 49.5 (17- 80) idi. Hastaların klinik ve demografik verileri toplandı. Febril nötropenik atak ve klinik değişkenler (tanı, yaş, cinsiyet, kemoterapi rejimi, kök hücre transplantasyonu, nötropeni süresi, santral venöz kateter varlığı ve G-CSF kullanımı) arasındaki ilişki logistic regresyon modeli kullanılarak analiz edildi. Bulgular: Febril nötropenik atak 201(% 77) yatış periyodunda saptandı. Akut lösemi tanısı (OR: 3.36, % 95 CI, 1.16- 9.78, p: 0.02), kök hücre nakli (OR:8.77, %95 CI,2.41-31.82, p:0.001), G-CSF kullanımı (OR: 8.46, 95% CI, 3.28- 22.04, p: 0.000) ve nötropenik periyodun ≥ 10 gün olması (OR: 4.01, % 95 CI, 0.83- 19.24, p: 0.001) febril nötropenik atak için risk faktörü olarak saptandı.

Hematolojik malignite nedeniyle kemoterapi verilen hastalarda febril nötropenik atak gelişimi için risk faktörleri

Aim Febrile neutropenic attacks are an important problem during and after chemotherapy. We retrospectively reviewed the records of patients who were administered chemotherapy treatment to identify the risk factors for febrile neutropenic attacks. Materials and Methods: A total of 261 inpatient periods that included 154 patients (92 male and 62 female) between 2004 and 2006 were analyzed retrospectively. The median age was 49.5 (range, 17-80) years. Patients clinical and demographic data were collected. We analyzed the relationship between febrile neutropenic attacks and clinical variables (diagnosis, age, sex, chemotherapy regimen, stem cell transplantation, the length of the neutropenic period, the presence of central venous catheter, and granulocyte colony stimulating factor [G-CSF] use) by a stepwise logistic regression model. Results: Febrile neutropenic attacks were detected in 201 (77%) inpatient periods. A diagnosis of acute leukemia (OR: 3.36, 95% CI: 1.16-9.78, p=0.02), stem cell transplantation (OR: 8.77, 95% CI: 2.41-31.821, p=0.001), G-CSF use (OR: 8.46, 95% CI: 3.28-22.04, p=0.000) and length of the neutropenic period ≥ 10 days (OR: 4.01, 95% CI: 0.83-19.24, p=0.001) were risk factors for febrile neutropenic attacks. Conclusion: Acute leukemia, stem cell transplantation, length of the neutropenic period ≥ 10 days and treatment with G-CSF were the most important risk factors for febrile neutropenic attacks. The result that G-CSF was a risk factor for febrile neutropenia was attributed to the fever-inducing effect of this drug. The use of G-CSF should be questioned in neutropenic patients with fever, especially in those without signs and symptoms of infection. Sonuç: Akut lösemi, kök hücre nakli, nötropenik periyodun 10 günden uzun olması ve G-CSF kullanımı febril nötropenik atak için risk faktörü olarak saptanmıştır. G-CSF nin febril nötropeni için risk faktörü olması ilacın ateş yapıcı etkisine bağlanmıştır. Özellikle infeksiyon semptom ve bulgusu olmayan febril nötropenik hastalarda G-CSF kullanımı sorgulanmalıdır

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References 1. Nakagawa Y, Suzuki K, Masaoka T. Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. J Infect Chemother 2009;15(3):174-9. 2. Puig N, De La Rubia J, Jarque I, et al. Characteristics of and risk factors for pneumonia in patients with hematological malignancies developing fever after autologous blood stem cell transplantation. Leuk Lymphoma 2007;48(12):2367-74. 3. Gil L, Styczynski J, Komarnicki M. Infectious complication in 314 patients after high-dose therapy and autologous hematopoietic stem cell transplantation: Risk factors analysis and outcome. Infection 2007;35(6):421-7. 4. Park Y, Kim DS, Park SJ, et al. The suggestion of a risk stratification system for febrile neutropenia in patients with hematologic disease. Leuk Res 2010;34(3):294-300. 5. El-Maghraby SM, Moneer MM, Ismail MM, Shalaby LM, El-Mahallawy HA. The diagnostic value of C-reactive protein, interleukin-8, and monocyte chemotactic protein in risk stratification of febrile neutropenic children with hematologic malignancies. J Pediatr Hematol Oncol 2007;29(3):131-6. 6. Jeddi R, Achour M, Amor RB, et al.Factors associated with severe sepsis: prospective study of 94 neutropenic febrile episodes. Hematology 2010;15(1):28-32. 7. Jeddi R, Ghédira H, Ben Amor R, et al. Risk factors of septic shock in patients with hematologic malignancies and Pseudomonas infections. Hematology 2011;16(3):160-5. 8. Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2002;18(16):3038-51. 9. Kamana M, Escalante C, Mullen CA, Frisbee-Hume S, Rolston KV. Bacterial infections in low-risk, febrile neutropenic patients. Cancer 2005;104(2):422-6. 10. Lanoix JP, Pluquet E, Lescure FX, et al. Bacterial infection profiles in lung cancer patients with febrile neutropenia. BMC Infect Dis 2011;27(11):183. 11. Cullen M, Steven N, Billingham L, et al; Simple Investigation in Neutropenic Individuals of the Frequency of Infection after Chemotherapy +/- Antibiotic in a Number of Tumours (SIGNIFICANT) Trial Group. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 2005;353(10):988-98. 12. Pagano L, Caira M, Rossi G, et al; Hema e-Chart Group, Italy. A prospective survey of febrile events in hematological malignancies. Ann Hematol 2012;91(5):767-74. 13. Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R. Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 2002;81(7):374-7. 14. Reich G, Mapara MY, Reichardt P, Dörken B, Maschmeyer G. Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant 2001;27(5):525-9. 15. Salazar R, Solá C, Maroto P, et al. Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999;23(1):27-33. 16. Ha Ye, Song JH, Kang WK, et al. Clinical factors predicting bacteremia in low-risk febrile neutropenia after anti-cancer chemotherapy. Support Care Cancer 2011;19(11):1761-7. 17. Sacar S, Hacioglu SK, Keskin A, Turgut H. Evaluation of febrile neutropenic attacks in a tertiary care medical center in Turkey. J Infect Dev Ctries 2008;2(5):359-63. 18. Pagano L, Caira M, Rossi G, et al; Hema e-Chart Group, Italy. A prospective survey of febrile events in hematological malignancies. Ann Hematol 2012; 91(5):767-74. 19. Horasan ES, Ersoz G, Tombak A, Tiftik N, Kaya A. Bloodstream infections and mortality-related factors in febrile neutropenic cancer patients. Med Sci Monit 2011;17(5):CR304-9. 20. Hoenigl M, Zollner-Schwetz I, Sill H, et al. Epidemiology of invasive fungal infections and rationale for antifungal therapy in patients with haematological malignancies. Mycoses 2011;54(5):454-9. 21. Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006;24(19):3187-205. 22. Altwairgi AK, Hopman WM, Mates M. Real-world impact of granulocyte-colony stimulating factor on febrile neutropenia. Curr Oncol 2013;20(3):e171-9. 23. Milkovich G, Moleski RJ, Reitan JF, et al. Comparative safety of filgrastim versus sargramostim in patients receiving myelosuppressive chemotherapy. Pharmacotherapy 2000;20(12):1432-40. 24. Anderlini P, Donato M, Chan KW, et al. Allogeneic blood progenitor cell collection in normal donors after mobilization with filgrastim: the M.D. Anderson Cancer Center experience. Transfusion 1999;39(6):555-60. 25. de la Rubia J, Martínez C, Solano C, et al. Administration of recombinant human granulocyte colony-stimulating factor to normal donors: results of the Spanish National Donor Registry. Spanish Group of Allo-PBT. Bone Marrow Transplant 1999;24(7):723-8. 26. Murata M, Harada M, Kato S, et al. Peripheral blood stem cell mobilization and apheresis: analysis of adverse events in 94 normal donors. Bone Marrow Transplant 1999;24(10):1065-71. 27. Swati M, Gita N, Sujata B, Farah J, Preeti M. Microbial etiology of febrile neutropenia. Indian J Hematol Blood Transfus 2010;26(2):49-55. 28. Yoo JH, Choi SM, Lee DG, et al. Prognostic factors influencing infection-related mortality in patients with acute leukemia in Korea. J Korean Med Sci 2005; 20(1): 31-5. 29. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52(4):427-31. 30. de Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F; ESMO Guidelines Working Group. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol 2010;21(Suppl 5):v252-6.