Outcome of Febrile Neutropenic Patients on Granulocyte Colony Stimulating Factor in a Tertiary Care Hospital

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapyand improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluationof granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes ofprolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF infebrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANCwith mortality and hospital discharge.
Methods: A prospective cross sectional study was carried at an oncologyward at Aga Khan University hospital from January 2010 to June 2011. All adult patients who were admittedand treated with GCSF for chemotherapy induced febrile neutropenia were included. Multivariable regressionwas conducted to identify the factors related with poor outcomes.
Results: A total of 131 patients with febrileneutropenia were identified with mean age of 43.2 (18-85) years, 79 (60%) being ≤50. Seventy-five (57%) hadsolid tumors and 56 (43%) hematological malignancies, including lymphoma. Fifty seven (43.5%) had an ANCless 100 cells/mm3, 34 (26%) one between100-300 cells/mm3 and 40 (31%) an ANC greater than 300 cells/mm3.Thirty (23%) patients showed ANC recovery in 1-3 days, and 74(56%) within 4-7 days. Thirteen (10%) patientsshowed no recovery. The overall mortality was 18 (13.7%) patients. The mean time for ANC recovery seen inhematological malignancies was 6.34 days whereas for solid tumors it was 4.88 days. Patients with ANC <100cells/mm3 were more likely to die than patients with ANC >300 cells/mm3 by a factor of 4.3. Similarly patients>50 years of age were 2.7 times more likely to die than younger patients.
Conclusion: Our study demonstratedthat use of GCSF, in addition to intravenous antibiotics, in treatment of patients with chemotherapy inducedfebrile neutropenia accelerates neutrophil recovery, and shortens antibiotic therapy and hospitalization. Wepropose to risk classify the patients at the time of admission to evaluate the cost effectiveness of this approachin a resource constrained setup.