British Journal of Cancer (2011) 105, 612 – 617 & 2011 Cancer Research UK All rights reserved 0007 – 0920/11 www.bjcancer.com C l i n i c a l S t u d i e s Prognostic evaluation of febrile neutropaenia in apparently stable adult cancer patients A Carmona-Bayonas*,1, J Go´ mez2, E Gonza´ lez-Billalabeitia1, M Canteras3, A Navarrete4, ML Gonza´ lvez4, V Vicente1 and F Ayala de la Pen˜ a1 1Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marque´s de los Ve´lez, S/n 30001, Murcia, Spain; 2Department of Infectious Diseases, Hospital Virgen de la Arrixaca, Carretera de Madrid-Cartagena, S/n 30120, Murcia, Spain; 3Department of Biostatistics, Faculty of Medicine, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain; 4Department of Medical Oncology, Hospital Virgen de la Arrixaca, Carretera de Madrid-Cartagena, S/n 30120, Murcia, Spain BACKGROUND: Predictive models to identify low-risk febrile neutropaenia (FN) have been developed with heterogeneous samples, which included stable and unstable patients, solid tumours, acute leukaemia and bone marrow transplantation. These models fail to recognise 5 – 15% of cases with unexpected complications, and literature specifically addressing apparently stable patients (ASPs) is scarce. METHODS: We reviewed 861 episodes of FN in outpatients with solid tumours, including 692 (80%) episodes with apparent clinical stability. We aimed to investigate the prognosis of this latter group and explore the possibility of stratifying it according to the presenting features. A case – control study was performed and the MASCC index was evaluated. RESULTS: The rates of complications and bacteraemia in ASPs were 7.3% and 6.2%, respectively. The MASCC index yielded a low sensitivity to detect complications (36%). Prognostic factors were identified: ECOG performance status X2, chronic bronchitis, chronic heart failure, stomatitis NCI grade X2, monocytes o200 mm 3 and stress hyperglycaemia. CONCLUSION: A very simple assessment is useful to classify the patients with FN according to the risk of complications. A few additional variables may predict the clinical course of the patients. We additionally show that the MASCC index applied to this specific group has a low sensitivity to predict complications. British Journal of Cancer (2011) 105, 612 – 617. doi:10.1038/bjc.2011.284 www.bjcancer.com Published online 2 August 2011 & 2011 Cancer Research UK Keywords: febrile neutropaenia; apparently stable patients; prognostic model Febrile neutropaenia (FN) is a common complication in cancer patients treated with chemotherapy. Although most of the cases are successfully solved with antibiotic treatment, a percentage of them can develop serious complications, and mortality is still significant in some settings (Sipsas et al, 2005). The prognostic models of Talcott and MASCC (see Table 1) were developed to predict the clinical outcome of patients with FN (Talcott et al, 1988; Klastersky et al, 2000). The latter model was validated several times and it is more accurate than Talcott’s classification (Talcott et al, 1992; Uys et al, 2004). However, some problems still remain in the clinical setting. The derivation and validation of both models involved heterogeneous samples, with solid tumours, acute leukaemia and bone marrow transplantation (BMT), which differ in their baseline characteristics. Therefore, FN is managed differently in each particular scenario (Rossini et al, 1994; Nakagawa et al, 2009). In the particular setting of Medical Oncology, the most common situations are moderate intensity chemotherapy, ambulatory setting, no profound immunosuppression and clinical stability at the onset (Talcott et al, 1988). In this situation, the rate of complications is around 9 – 15% according to the MASCC score *Correspondence: Dr A Carmona-Bayonas; E-mail: alberto.carmonabayonas@gmail.com Revised 31 May 2011; accepted 5 July 2011; published online 2 August 2011 (Klastersky et al, 2000, 2006). Although this group is less vulnerable, the introduction of home therapy and oral antibiotics can make the consequences of misclassification more relevant. In addition, the patients enrolled in these studies showed a wide clinical spectrum, from fever without focus to multiorgan dysfunction (Talcott et al, 1988; Klastersky et al, 2000). As a result, the MASCC index includes some factors that define severe sepsis (Nguyen et al, 2006), even though they automatically point to high risk scenarios, thereby making the prediction irrelevant for changing medical decisions. Otherwise, the available literature regarding clinically stable patients is scarce (Moon and Chun, 2009). In this situation, there is also a rationale for incorporating biological variables into risk prediction (Jimeno et al, 2004; Uys et al, 2004). Therefore, it is still important to describe the clinical behaviour of more homogeneous samples of patients and, in particular, those who appear clinically stable at presentation. The primary aim of this study is to provide more data about the clinical features and prognosis of this specific population. The secondary objective is to explore the possibility of stratifying the group according to the presenting clinical features. PATIENTS AND METHODS Patients The medical records of all adults (X18 years), outpatients, admitted between 1996 and 2004, with fever X38 1C over 1 h,