Identification of patients at risk for early death after conventional chemotherapy in solid tumours and lymphomas.
1-5% of cancer patients treated with cytotoxic chemotherapy die within a month after the administration of chemotherapy. Risk factors for these early deaths (ED) are not well known. The purpose of this study was to establish a risk model for ED after chemotherapy applicable to all tumour types. The model was delineated in a series of 1051 cancer patients receiving a first course of chemotherapy in the Department of Medicine of the Centre Léon Bérard (CLB) in 1996 (CLB-1996 cohort), and then validated in a series of patients treated in the same department in 1997 (CLB-1997), in a prospective cohort of patients with aggressive non-Hodgkin's lymphoma (NHL) (CLB-NHL), and in a prospective cohort of patients with metastatic breast cancer (MBC series) receiving first-line chemotherapy. In the CLB-1996 series, 43 patients (4.1%) experienced early. In univariate analysis, age > 60, PS > 1, lymphocyte (ly) count <or= 700 microl(-1)immediately prior to chemotherapy (d1), d1-platelet count <or= 150 Gl(-1), and the type of chemotherapy were significantly correlated to the risk of early death (P<or= 0.01). Using logistic regression, PS > 1 (hazard ratio 3.9 (95% Cl 2.0-7.5)) and d1-ly count <or= 700 microl(-1) (3.1 (95% Cl 1.6-5.8)) were identified as independent risk factors for ED. The calculated probability of ED was 20% (95% Cl 10-31) in patients with both risk factors, 6% (95% Cl 4-9) for patients with only 1 risk factor, and 1.7% (95% Cl 0.9-3) for patients with none of these 2 risk factors. In the CLB-97, CLB-NHL and MBC validation series, the observed incidences of early death in patients with both risk factors were 19%, 25% and 40% respectively and did not differ significantly from those calculated in the model. In conclusion, poor performance status and lymphopenia identify a subgroup of patients at high risk for early death after chemotherapy.
Ray-Coquard
I
I
Centre Léon Bérard, Lyon, France
Ghesquière
H
H
Bachelot
T
T
Borg
C
C
Biron
P
P
Sebban
C
C
LeCesne
A
A
Chauvin
F
F
Blay
J Y
JY
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008223:Lymphoma / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000970:Antineoplastic Agents