title: Predicting individual risk of neutropenic complications in patients receiving cancer chemotherapy.
abstract: BACKGROUND
  A prospective cohort study was undertaken to develop and validate a risk model for neutropenic complications in cancer patients receiving chemotherapy.
  
  
  METHODS
  The study population consisted of 3760 patients with common solid tumors or malignant lymphoma who were beginning a new chemotherapy regimen at 115 practice sites throughout the United States. A regression model for neutropenic complications was developed and then validated by using a random split-sample selection process.
  
  
  RESULTS
  No significant differences in the derivation and validation populations were observed. The risk of neutropenic complications was greatest in cycle 1 with no significant difference in predicted risk between the 2 cohorts in univariate analysis. After adjustment for cancer type and age, major independent risk factors in multivariate analysis included: prior chemotherapy, abnormal hepatic and renal function, low white blood count, chemotherapy and planned delivery ≥85%. At a predicted risk cutpoint of 10%, model test performance included: sensitivity 90%, specificity 59%, and predictive value positive and negative of 34% and 96%, respectively. Further analysis confirmed model discrimination for risk of febrile neutropenia over multiple chemotherapy cycles.
  
  
  CONCLUSIONS
  A risk model for neutropenic complications was developed and validated in a large prospective cohort of patients who were beginning cancer chemotherapy that may guide the effective and cost-effective use of available supportive care.
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina 27710, USA. Gary.Lyman@Duke.Edu
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Kuderer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: Debra A
authors.initials: DA
authors.lastname: Wolff
authors.forename: Eva
authors.initials: E
authors.lastname: Culakova
authors.forename: Marek S
authors.initials: MS
authors.lastname: Poniewierski
authors.forename: David C
authors.initials: DC
authors.lastname: Dale
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment
chemical_list: D000970:Antineoplastic Agents