Elderly haematological patients with chemotherapy-induced febrile neutropenia have similar rates of infection and outcome to younger adults: a prospective study of risk-adapted therapy.
We prospectively evaluated 131 consecutive episodes of fever and chemotherapy-induced neutropenia in 85 adults with haematological malignancies to determine whether older patients (aged < 60 years) have different causes of fever and outcome than younger adults (aged < 60 years). Patients were stratified into high-risk and low-risk groups according to previously published criteria. High-risk patients received ceftazidime plus amikacin and low-risk patients received ceftazidime alone. All patients were hospitalized until fever and neutropenia resolved. Ninety one high-risk episodes were documented: 56 occurring in older patients (mean age 69 years) and 35 in younger adults (mean age 45 years). Non-Hodkgin's lymphoma and acute myeloid leukaemia were the most frequent underlying neoplasias in both age groups. Intensity of chemotherapy was similar in both age groups. Mean neutrophil count at entry, median duration of neutropenia, rate of documented infection, incidence of bacteraemia, response to therapy, overall mortality and infectious mortality were similar in the two high-risk age subgroups. The elderly subgroup had a trend to have more Gram-negative infections and the younger patients more Gram-positive infections. In addition, 40 low-risk episodes were registered: 29 in elderly patients (mean age 68 years) and 11 in younger patients (mean age 44 years). Elderly low-risk patients had more concurrent diseases that younger ones (P = 0.124). Mean neutrophil count at entry, median duration of severe neutropenia and rate of response were similar in the two age subgroups. All low-risk patients survived. In conclusion, elderly haematological cancer patients with febrile neutropenia show similar rates of infection and outcome to younger ones.
García-Suárez
Julio
J
Service of Haematology, Príncipe de Asturias University Hospital, Department of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain. jgarciasu@hupa.insalud.es
Krsnik
Isabel
I
Reyes
Eduardo
E
De Miguel
Dunia
D
Hernanz
Nuria
N
Barr-Alí
Mohamed
M
Burgaleta
Carmen
C
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000276:immunology; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016009:Chi-Square Distribution; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000276:immunology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000276:immunology; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000583:Amikacin; D002442:Ceftazidime