Factors related to | Factor | Effect on risk |
Patient characteristics | Advanced age | Risk increases if age ≥65 years[1] |
Performance status | Risk increases if ECOG performance score ≥2[1] |
Nutritional status | Risk increases if albumin <35 g/L[2,3] |
Prior FN episode | Risk in cycles 2 to 6 is 4-fold greater if FN episode occurs in cycle 1[4] |
Comorbidities | FN odds increase by 27, 67, and 125% for 1, 2, or 3 or more comorbidities, respectively[1,5] |
Underlying malignancy | Cancer diagnosis | Diagnosis | Reported FN rates (%) |
Acute leukemia/MDS | 85.0 to 95.0[6-9] |
High-grade lymphoma | 35.0 to 71.0*[10] |
Soft tissue sarcoma | 27.0 (95% CI 19.0-34.5)[4,5,11,12] |
NHL/myeloma | 26.0 (95% CI 22.0-29.0)[4,5,11,12] |
Germ cell carcinoma | 23.0 (95% CI 16.6-29.0)[4,5,11,12] |
Hodgkin lymphoma | 15.0 (95% CI 6.6-24.0)[4,5,11,12] |
Ovarian carcinoma | 12.0 (95% CI 6.6-17.7)[4,5,11,12] |
Lung cancers | 10.0 (95% CI 9.8-10.7)[4,5,11,12] |
Colorectal cancers | 5.5 (95% CI 5.1-5.8)[4,5,11,12] |
Head and neck carcinoma | 4.6 (95% CI 1.0-8.2)[4,5,11,12] |
Breast cancer | 4.4 (95% CI 4.1-4.7)[4,5,11,12] |
Prostate cancer | 1.0 (95% CI 0.9-1.1)[4,5,11,12] |
Cancer stage | Risk increases for advanced stage (≥2)[13] |
Remission status | Risk increases if not in remission[8,14] |
Cancer treatment response | Risk is lowest if patient has a CR |
If patient has a PR, FN risk is greater for acute leukemia than for solid tissue malignancies[8] |
FN risk is higher if persistent, refractory, or progressive disease despite treatment[15,16] |
Treatment of malignancy | Cytotoxic regimen | Risk is higher with regimens that administer: - Anthracyclines at doses ≥90 mg/m2
- Cisplatin at doses ≥100 mg/m2
- Ifosfamide at doses ≥9 g/m2
- Cyclophosphamide at doses ≥1 g/m2
- Etoposide at doses ≥500 mg/m2
- Cytarabine at doses ≥1 g/m2
- High dose density
- Anthracycline + taxane, and cyclophosphamide or gemcitabine, for breast cancer
|
Dose intensity | Increased risk if >85% of scheduled doses are administered[12,17] |
Degree and duration of GI and/or oral mucositis | Risk is greatest if NCI mucositis grade is ≥3 (GI) or if peak score on OMAS is ≥2[9,18,19] |
Degree and duration of cytopenia | Profound, protracted neutropenia | ANC <100/mL for ≥7 days[20-22] |
Lymphopenia | ALC <700/mL (ANC surrogate)[11,23] |
Monocytopenia | AMC <150/mL (ANC surrogate)[24] |