title: Predictors of severe and febrile neutropenia during primary chemotherapy for ovarian cancer.
abstract: OBJECTIVE
  To identify factors that increase the risk of neutropenic events in women with advanced ovarian carcinoma receiving initial chemotherapy.
  
  
  METHODS
  Multi-center retrospective study of women with FIGO stage III-IV epithelial ovarian cancer treated postoperatively with multi-agent intravenous chemotherapy from 1995 to 2008. Outcomes were severe (SN; absolute neutrophil count [ANC]<500/mm(3)) and febrile neutropenia (FN; ANC<1000/mm(3) and temperature>38.1°C). Cumulative risk of neutropenic events was estimated by Kaplan Meier method. Multivariate analysis was by Cox proportional hazard regression.
  
  
  RESULTS
  Three hundred twenty-six patients met inclusion criteria. There were 251 SN events among 140 (43%) patients and 24 FN events among 22 (7%) patients. Univariate predictors of SN were body surface area<2.0m(2) (p=0.03), body mass index (BMI)<30 kg/m(2) (p<0.01), Caucasian race (p<0.01), treatment on research protocols (p<0.01), non-carboplatin-containing regimens (p<0.01), and planned relative dose intensity (RDI)>85% of standard (p=0.02). Women over age 60 were more likely to develop FN (p=0.05). Multivariate predictors of SN were treatment on research protocols (hazard ratio [HR] 1.93; p<0.01), Caucasian race (HR 2.13; p=0.01), and planned RDI>85% (HR 1.69; p=0.05); predictors of FN were age>60 (HR 2.84; p=0.05) and non-carboplatin containing regimens (HR 4.06; p<0.01).
  
  
  CONCLUSIONS
  While SN is fairly common, FN occurs infrequently in women with EOC undergoing taxane and platin-based chemotherapy and primary prophylactic growth factor support is not indicated. However, women older than 60 years of age receiving non-carboplatin containing regimens are at higher risk for FN and warrant closer surveillance.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, USA.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Laskey
authors.forename: Marek S
authors.initials: MS
authors.lastname: Poniewierski
authors.forename: Micael A
authors.initials: MA
authors.lastname: Lopez
authors.forename: Rabbie K
authors.initials: RK
authors.lastname: Hanna
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced* / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D016179:Granulocyte Colony-Stimulating Factor