Research in the October 2018 issue of JNCCN—Journal of the National Comprehensive Cancer Network–identifies risk factors for chemotherapy-induced febrile neutropenia.
The researchers studied 15,971 patients who were diagnosed with non-Hodgkin lymphoma, breast, lung, colorectal, ovarian, or gastric cancer and treated with myelosuppressive chemotherapy[1] at Kaiser Permanente Southern California between the years 2000 and 2009. Of those, 4.3% developed FN in the first chemotherapy cycle.
The study’s authors found that longer term use and more recent use of corticosteroids appeared to increase the risk of FN the most, leading to three and two times the risk, respectively. Certain dermatologic and mucosal conditions (including gastritis, dermatitis, and psoriasis), as well as the use of intravenous antibiotics prior to chemotherapy were also associated with higher risk of FN during the first chemotherapy cycle.
The research team was surprised to find a lack of association between prior or concurrent radiation therapy and FN, since radiation has been linked to bone marrow suppression.
However, they did not account for radiation field or dose, and believe more comprehensive evaluation is needed. They also found no clear association between oral antibiotic use and FN risk.
The results suggest IV antibiotics may have a more profound impact on the balance of bacterial flora and other immune functions, though it is also possible that patients who received antibiotics intravenously rather than orally were generally sicker and more prone to severe infection.
The study was led by Chun Rebecca Chao of the Kaiser Permanente Southern California Department of Research & Evaluation, with the intention of learning how to reduce the number of patients who experience this serious and life-threatening side effect in the future.
