Febrile neutropaenia in apparently stable outpatients A Carmona-Bayonas et al that the evaluation of biological variables is interesting in FN. Particularly, some reports have found that acute-phase reactants are useful as adjuvants to the clinical models (Kern et al, 2001; Nijhuis et al, 2005). Finally, our model has some other limitations beyond the requirement of validation. The selection of variables was based on easy availability, which excluded some potentially informative factors. Furthermore, all our patients were admitted to the hospital and received intravenous treatment, which might compromise the applicability of the model in the ambulatory setting. As a conclusion, we have shown that a very simple assessment (ASP vs CUP) can classify cancer patients with FN according to the risk of complications. A few additional variables predict the clinical course of this population. Finally, the MASCC index applied to this specific group has a low sensitivity to predict complications. REFERENCES Bochud PY, Eggiman P, Calandra T, Van Melle G, Saghafi L, Francioli P (1994) Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 18: 25 – 31 Dandona P, Aljada A, Bandyopadhyay A (2003) The potential therapeutic role of insulin in acute myocardial infarction in patients admitted to intensive care and in those with unspecified hyperglycemia. Diabetes Care 26: 516 – 519 Escalante CP, Rubenstein EB, Rolston KV (1996) Outpatient antibiotic treatment in low-risk febrile neutropenic cancer patients. Support Care Cancer 4: 358 – 363 Groeger JS, Lemeshow S, Price K (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16: 761 – 770 Hughes WT, Armstrong D, Bodey GP (2002) Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34: 730 – 751 Jimeno A, Garc´ıa-Velasco A, del Val O (2004) Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Cancer 100: 2462 – 2469 Kern WV, Heiss M, Steinbach G (2001) Prediction of gram-negative bacteremia in patients with cancer and febrile neutropenia by means of interleukin-8 levels in serum: targeting empirical monotherapy versus combination therapy. Clin Infect Dis 32: 832 – 835 Klastersky J, Ameye L, Maertens J (2007) Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 30: 51 – 59 Klastersky J, Paesmans M, Georgala A (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24: 4129 – 4134 Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J (2000) 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 18: 3038 – 3051 Moon JM, Chun BJ (2009) Predicting the complicated neutropenic fever in the emergency department. Emerg Med J 26: 802 – 806 Mullen CA, Petropoulos D, Roberts WM (1999) Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients. Cancer 86: 126 – 134 Nakagawa Y, Suzuki K, Masaoka T (2009) Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. J Infect Chemother 15: 174 – 179 Nguyen HB, Emanuel PR, Fredrick MA (2006) Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med 48: 54 Nijhuis CO, Kamps WA, Daenen SM (2005) Feasibility of withholding antibiotics in selected febrile neutropenic cancer patients. J Clin Oncol 23: 7437 – 7444 Oguz A, Karadeniz C, Ckitak EC, Cil V (2006) Which one is a risk factor for chemotherapy-induced febrile neutropenia in childhood solid tumors: early lymphopenia or monocytopenia? Pediatr Hematol Oncol 23: 143 – 151 Rackoff WR, Gonin R, Robinson C, Kreissman SG, Breitfeld PB (1996) Predicting the risk of bacteremia in children with fever and neutropenia. J Clin Oncol 14: 919 – 924 Rossini F, Pioltelli P, Mingozzi S (1994) Amikacin and ceftazidime as empirical antibiotic therapy in severely neutropenic patients: analysis of prognostic factors. Support Care Cancer 2: 259 – 265 Rubenstein EB, Rolston K, Escalante C (1993) Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer 71: 3640 – 3646 Sanz MA, Lo´pez J, Lahuerta JJ (2002) Cefepime plus amikacin versus piperacillin-tazobactam plus amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia: results of an open, randomized, multicentre trial. J Antimicrob Chemother 50: 79 – 88 Sipsas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103: 1103 – 1113 Talcott JA, Finberg R, Mayer RJ, Goldman L (1988) The medical course of cancer patients with fever and neutropenia: clinical identification of a low-risk subgroup at presentation. Arch Intern Med 148: 2561 – 2568 Talcott JA, Siegel RD, Finberg R, Goldman L (1992) Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol 10: 316 – 322 Talcott JA, Whalen A, Clark J, Rieker PP, Finberg R (2004) Home antibiotic therapy for low-risk cancer patients with fever and neutropenia: a pilot study of 30 patients based on a validated prediction rule. J Clin Oncol 12: 107 – 114 Uys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer 12: 555 – 560 Van den Berghe G, Wouters P, Weekers F (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345: 1359 – 1367 This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. 617 s e i d u t S l a c i n i l C & 2011 Cancer Research UK British Journal of Cancer (2011) 105(5), 612 – 617