Febrile neutropenia is the most common life-threatening complication of cancer therapy.[1]Jairam V, Lee V, Park HS, et al. Treatment-related complications of systemic therapy and radiotherapy. JAMA Oncol. 2019 Jul 1;5(7):1028-35.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2729685
http://www.ncbi.nlm.nih.gov/pubmed/30946433?tool=bestpractice.com
In the US, the incidence of febrile neutropenia is estimated at >100,000 events a year, accounting for 5.2% of all cancer-related hospitalisations in adults.[8]Tai E, Guy GP, Dunbar A, et al. Cost of cancer-related neutropenia or fever hospitalizations, United States, 2012. J Oncol Pract. 2017 Jun;13(6):e552-61.
http://ascopubs.org/doi/full/10.1200/JOP.2016.019588
http://www.ncbi.nlm.nih.gov/pubmed/28437150?tool=bestpractice.com
Estimates of the proportion of patients receiving cancer treatment who experience febrile neutropenia vary from 10% to 20%.[9]Weycker D, Li X, Edelsberg J, et al. Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract. 2015 Jan;11(1):47-54.
https://ascopubs.org/doi/10.1200/JOP.2014.001492
http://www.ncbi.nlm.nih.gov/pubmed/25491042?tool=bestpractice.com
[10]Weycker D, Barron R, Kartashov A, et al. Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings. J Oncol Pharm Pract. 2014 Jun;20(3):190-8.
http://www.ncbi.nlm.nih.gov/pubmed/23824496?tool=bestpractice.com
[11]Crawford J, Dale DC, Kuderer NM, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw. 2008 Feb;6(2):109-18.
http://www.ncbi.nlm.nih.gov/pubmed/18319047?tool=bestpractice.com
Incidence appears to be highest during the first cycle of chemotherapy, in the elderly (age >65 years), and in those with comorbidities.[9]Weycker D, Li X, Edelsberg J, et al. Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract. 2015 Jan;11(1):47-54.
https://ascopubs.org/doi/10.1200/JOP.2014.001492
http://www.ncbi.nlm.nih.gov/pubmed/25491042?tool=bestpractice.com
[12]Lyman GH, Morrison VA, Dale DC, et al. Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin's lymphoma receiving CHOP chemotherapy. Leuk Lymphoma. 2003 Dec;44(12):2069-76.
http://www.ncbi.nlm.nih.gov/pubmed/14959849?tool=bestpractice.com
[11]Crawford J, Dale DC, Kuderer NM, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw. 2008 Feb;6(2):109-18.
http://www.ncbi.nlm.nih.gov/pubmed/18319047?tool=bestpractice.com
[13]Pettengell R, Bosly A, Szucs TD, et al. Multivariate analysis of febrile neutropenia occurrence in patients with non-Hodgkin lymphoma: data from the INC-EU Prospective Observational European Neutropenia Study. Br J Haematol. 2009 Mar;144(5):677-85.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2008.07514.x
http://www.ncbi.nlm.nih.gov/pubmed/19055662?tool=bestpractice.com
[14]Chao C, Page JH, Yang SJ, et al. History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis. Ann Oncol. 2014 Sep;25(9):1821-9.
https://www.annalsofoncology.org/article/S0923-7534(19)35094-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24915871?tool=bestpractice.com
[15]Leon Rapoport B, Garcia-Morillo M, Font C, et al. A prospective, real-world, multinational study of febrile neutropenia (FN) occurrence in oncology patients receiving chemotherapy with intermediate risk of FN: a MASCC Neutropenia, Infection, and Myelosuppression Study Group initiative. Support Care Cancer. 2023 Oct 13;31(12):628.
https://link.springer.com/article/10.1007/s00520-023-08071-0
http://www.ncbi.nlm.nih.gov/pubmed/37828258?tool=bestpractice.com
Febrile neutropenia frequency and mortality are higher in patients with haematological malignancy than those with solid tumours.[16]Caggiano V, Weiss RV, Rickert TS, et al. Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer. 2005 May 1;103(9):1916-24.
https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.20983
http://www.ncbi.nlm.nih.gov/pubmed/15751024?tool=bestpractice.com
[17]Kuderer NM, Dale DC, Crawford J, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006 May 15;106(10):2258-66.
https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.21847
http://www.ncbi.nlm.nih.gov/pubmed/16575919?tool=bestpractice.com
In one retrospective multi-centre database study of adult cancer patients hospitalised with febrile neutropenia between 1995 and 2000, the average inpatient mortality rate associated with febrile neutropenia was 14.3% for those with leukaemia, 8.0% for those with solid tumours, and 8.9% for those with lymphoma.[17]Kuderer NM, Dale DC, Crawford J, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006 May 15;106(10):2258-66.
https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.21847
http://www.ncbi.nlm.nih.gov/pubmed/16575919?tool=bestpractice.com
A subsequent cross-sectional study of 14 US cancer centres reported 30-day mortality of 9.6% among patients with haematological malignancies with bloodstream infection in the setting of febrile neutropenia.[18]Zimmer AJ, Stohs E, Meza J, et al. Bloodstream infections in hematologic malignancy patients with fever and neutropenia: are empirical antibiotic therapies in the United States still effective? Open Forum Infect Dis. 2022 Jul;9(7):ofac240.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9277632
http://www.ncbi.nlm.nih.gov/pubmed/35854988?tool=bestpractice.com