Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy

Publication Date: February 20, 2018

Key Points

Key Points

  • Neutropenia, a decrease in the absolute neutrophil count (ANC), occurs frequently in recipients of chemotherapy.
  • The greatest risk of infection occurs in patients who experience profound, prolonged neutropenia after chemotherapy, which is most likely to occur in the period prior to engraftment during hematopoietic cell transplantation and following induction chemotherapy for acute leukemia.
  • Fever is often the only sign or symptom of infection, although clinicians should also be mindful that severely or profoundly neutropenic patients may present with suspected infection in an afebrile state, or even hypothermic.
  • The rate of major complications (e.g., hypotension, acute renal, respiratory or heart failure) in the context of neutropenic fever syndromes is approximately 25-30%, and mortality up to 11%.
    • In the setting of severe sepsis or septic shock, hospital mortality may be as high as 50%.

Triage to Initial Empirical Antibiotic Therapy

...itial Empirical Antibiotic Therapy...

Figure 1. Triage to Initial Empirical Antiba...

...gure 1. Triage to Initial Empirical An...

...s defined as a single oral temperature of ≥38...

...h an influenza-like illness (sudde...

...tration of empirical antibiotics:...


 Identification of Candidates for Outpatient Management

...tification of Candidates for Outpatient Manage...

...ntification of Candidates for Outp...

...gure 2. Identification of Candidates for Outpa...

...l judgment should be used when selecting cand...

...SCC index or Talcott’s rules are recomme...

...In the setting of a high prevalence of ESBL-pr...

...ents with febrile neutropenia who...

e Low-risk outpatients with febril...

...atients with fever and neutropenia who are ap...

...tients with FN who are undergoing outpatient...


Table 1. Additional Specific Clinical Criteriaa That May Be Used to Exclude Oncology Patients Who Have Fever and Neutropenia from Initial Outpatient Care Even with a MASCC Score ≥21

...le 1. Additional Specific Clinical...

Table 2. MASCC Scoring System to Identify Patients With Cancer and Febrile Neutropenia at Low Risk of Medical Complicationsa

...Scoring System to Identify Patients...

Table 3. The Talcott’s Classification

Table 3. The Talcott’s ClassificationHaving t...

Table 4. The Clinical Index of Stable Febrile Neutropenia (CISNE) Includes Six Explanatory Variable Associated with Serious Complicationsa

...4. The Clinical Index of Stable Fe...