The multinational association for supportive care in cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients

Jean Klastersky, Marianne Paesmans, Edward B. Rubenstein, Michael Boyer, Linda Elting, Ronald Feld, James Gallagher, Jorn Herrstedt, Bernardo Rapoport, Kenneth Rolston, James Talcolt

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Abstract

Purpose: Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy, but some patients are at low risk for serious medical complications. The purpose of this study was to develop an internationally validated scoring system to identify these patients. Materials and Methods: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected derivation set, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (756 patients), predictive factors were a burden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21; 95% confidence interval [Cl], 4.15 to 16.38) or moderate symptoms (weight, 3; OR, 3.70; 95% Cl, 2.18 to 6.29); absence of hypotension (weight, 5; OR, 7.62; 95% Cl, 2.91 to 19.89); absence of chronic obstructive pulmonary disease (weight, 4; OR, 5.35; 95% Cl, 1.86 to 15.46); presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies (weight, 4; OR, 5.07; 95% Cl, 1.97 to 12.95); outpatient status (weight, 3; OR, 3.51; 95% Cl, 2.02 to 6.04); absence of dehydration (weight, 3; OR, 3.81; 95% Cl, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95% Cl, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score ≥ 21 identified low-risk patients with a positive predictive value of 91%, specificity of 68%, and sensitivity of 71%. Conclusion: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective. (C) 2000 by American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)3038-3051
Number of pages14
JournalJournal of Clinical Oncology
Volume18
Issue number16
DOIs
StatePublished - Jan 1 2000

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Fever
Odds Ratio
Weights and Measures
Neoplasms
Febrile Neutropenia
Cost of Illness
Mycoses
Hematologic Neoplasms
Dehydration
Hypotension
Chronic Obstructive Pulmonary Disease
Outpatients
Prospective Studies
Confidence Intervals
Costs and Cost Analysis
Drug Therapy
Sensitivity and Specificity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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The multinational association for supportive care in cancer risk index : A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. / Klastersky, Jean; Paesmans, Marianne; Rubenstein, Edward B.; Boyer, Michael; Elting, Linda; Feld, Ronald; Gallagher, James; Herrstedt, Jorn; Rapoport, Bernardo; Rolston, Kenneth; Talcolt, James.

In: Journal of Clinical Oncology, Vol. 18, No. 16, 01.01.2000, p. 3038-3051.

Research output: Contribution to journalArticle

Klastersky, J, Paesmans, M, Rubenstein, EB, Boyer, M, Elting, L, Feld, R, Gallagher, J, Herrstedt, J, Rapoport, B, Rolston, K & Talcolt, J 2000, 'The multinational association for supportive care in cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients', Journal of Clinical Oncology, vol. 18, no. 16, pp. 3038-3051. https://doi.org/10.1200/JCO.2000.18.16.3038
Klastersky, Jean ; Paesmans, Marianne ; Rubenstein, Edward B. ; Boyer, Michael ; Elting, Linda ; Feld, Ronald ; Gallagher, James ; Herrstedt, Jorn ; Rapoport, Bernardo ; Rolston, Kenneth ; Talcolt, James. / The multinational association for supportive care in cancer risk index : A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. In: Journal of Clinical Oncology. 2000 ; Vol. 18, No. 16. pp. 3038-3051.
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abstract = "Purpose: Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy, but some patients are at low risk for serious medical complications. The purpose of this study was to develop an internationally validated scoring system to identify these patients. Materials and Methods: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected derivation set, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (756 patients), predictive factors were a burden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21; 95{\%} confidence interval [Cl], 4.15 to 16.38) or moderate symptoms (weight, 3; OR, 3.70; 95{\%} Cl, 2.18 to 6.29); absence of hypotension (weight, 5; OR, 7.62; 95{\%} Cl, 2.91 to 19.89); absence of chronic obstructive pulmonary disease (weight, 4; OR, 5.35; 95{\%} Cl, 1.86 to 15.46); presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies (weight, 4; OR, 5.07; 95{\%} Cl, 1.97 to 12.95); outpatient status (weight, 3; OR, 3.51; 95{\%} Cl, 2.02 to 6.04); absence of dehydration (weight, 3; OR, 3.81; 95{\%} Cl, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95{\%} Cl, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score ≥ 21 identified low-risk patients with a positive predictive value of 91{\%}, specificity of 68{\%}, and sensitivity of 71{\%}. Conclusion: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective. (C) 2000 by American Society of Clinical Oncology.",
author = "Jean Klastersky and Marianne Paesmans and Rubenstein, {Edward B.} and Michael Boyer and Linda Elting and Ronald Feld and James Gallagher and Jorn Herrstedt and Bernardo Rapoport and Kenneth Rolston and James Talcolt",
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AU - Paesmans, Marianne

AU - Rubenstein, Edward B.

AU - Boyer, Michael

AU - Elting, Linda

AU - Feld, Ronald

AU - Gallagher, James

AU - Herrstedt, Jorn

AU - Rapoport, Bernardo

AU - Rolston, Kenneth

AU - Talcolt, James

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N2 - Purpose: Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy, but some patients are at low risk for serious medical complications. The purpose of this study was to develop an internationally validated scoring system to identify these patients. Materials and Methods: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected derivation set, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (756 patients), predictive factors were a burden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21; 95% confidence interval [Cl], 4.15 to 16.38) or moderate symptoms (weight, 3; OR, 3.70; 95% Cl, 2.18 to 6.29); absence of hypotension (weight, 5; OR, 7.62; 95% Cl, 2.91 to 19.89); absence of chronic obstructive pulmonary disease (weight, 4; OR, 5.35; 95% Cl, 1.86 to 15.46); presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies (weight, 4; OR, 5.07; 95% Cl, 1.97 to 12.95); outpatient status (weight, 3; OR, 3.51; 95% Cl, 2.02 to 6.04); absence of dehydration (weight, 3; OR, 3.81; 95% Cl, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95% Cl, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score ≥ 21 identified low-risk patients with a positive predictive value of 91%, specificity of 68%, and sensitivity of 71%. Conclusion: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective. (C) 2000 by American Society of Clinical Oncology.

AB - Purpose: Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy, but some patients are at low risk for serious medical complications. The purpose of this study was to develop an internationally validated scoring system to identify these patients. Materials and Methods: Febrile neutropenic cancer patients were observed in a prospective multinational study. Independent factors assessable at fever onset, predicting low risk of complications, on a randomly selected derivation set, were assigned integer weights to develop a risk-index score, which was subsequently tested on a validation set. Results: On the derivation set (756 patients), predictive factors were a burden of illness indicating absence of symptoms or mild symptoms (weight, 5; odds ratio [OR], 8.21; 95% confidence interval [Cl], 4.15 to 16.38) or moderate symptoms (weight, 3; OR, 3.70; 95% Cl, 2.18 to 6.29); absence of hypotension (weight, 5; OR, 7.62; 95% Cl, 2.91 to 19.89); absence of chronic obstructive pulmonary disease (weight, 4; OR, 5.35; 95% Cl, 1.86 to 15.46); presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies (weight, 4; OR, 5.07; 95% Cl, 1.97 to 12.95); outpatient status (weight, 3; OR, 3.51; 95% Cl, 2.02 to 6.04); absence of dehydration (weight, 3; OR, 3.81; 95% Cl, 1.89 to 7.73); and age less than 60 years (weight, 2; OR, 2.45; 95% Cl, 1.51 to 4.01). On the validation set, a Multinational Association for Supportive Care in Cancer risk-index score ≥ 21 identified low-risk patients with a positive predictive value of 91%, specificity of 68%, and sensitivity of 71%. Conclusion: The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective. (C) 2000 by American Society of Clinical Oncology.

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