History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A
Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs
#MMPMID28954408
Andrès E
; Mourot-Cottet R
; Maloisel F
; Keller O
; Vogel T
; Séverac F
; Tebacher M
; Gottenberg JE
; Weber JC
; Kaltenbach G
; Goichot B
; Sibilia J
; Korganow AS
; Herbrecht R
J Clin Med
2017[Sep]; 6
(10
): ? PMID28954408
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BACKGROUND: Despite major advances in its prevention and treatment, febrile
neutropenia remains a most concerning complication of cancer chemotherapy.
Outside the oncology setting, however, only few data are currently available on
febrile neutropenia related to non-chemotherapy drugs. We report here data on 76
patients with febrile neutropenia related to non-chemotherapy drugs, followed up
in a referral center within a university hospital. PATIENTS AND METHODS: Data
from 76 patients with idiosyncratic drug-induced febrile neutropenia were
retrospectively reviewed. All cases were extracted from a cohort study on
agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg,
France). RESULTS: Mean patient age was 52.2 years old (range: 18-93) and gender
ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The
most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%),
neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory
agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main
clinical presentations upon hospitalization included isolated fever (30%), sore
throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%),
septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was
0.13 × 10(9)/L (range: 0-0.48). While in hospital, 22 patients (28.9%) worsened
clinically and required intensive care unit placement. All patients were promptly
treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth
factors. Mean duration of hematological recovery (neutrophil count ?1.5 ×
10(9)/L) was 7.5 days (range: 2-21), which was reduced to 0.7 days (range: 2-16)
(p = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of
patients, whereas eight died. CONCLUSIONS: Like in oncology and myelosuppressive
chemotherapy settings, idiosyncratic febrile neutropenia is typically serious,
about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock,
with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia,
modern and timely management (immediate broad spectrum antibiotherapy,
hematopoietic growth factors) may reduce infection-related mortality. All
practitioners should be aware of this potential side-effect that may even occur
in the event of "daily medication" exposure.
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