title: Predictive factors for severe and febrile neutropenia during docetaxel chemotherapy for castration-resistant prostate cancer.
abstract: BACKGROUND
  The aim of this study is to identify factors that increase the occurrence of severe neutropenia (SN) and febrile neutropenia (FN) during docetaxel treatment for castration-resistant prostate cancer (CRPC).
  
  
  METHODS
  We retrospectively reviewed 258 courses during the first three cycles among 95 patients. Docetaxel at a dose of 75 mg/m(2) was administered every 3 or 4 weeks. Patient background, laboratory data, and bone scan results were collected to assess predictive factors for SN and FN. We defined SN as an absolute neutrophil count (ANC) of <500/mm(3) and defined FN as an ANC of <1000/mm(3) with a body temperature of >38.3 °C.
  
  
  RESULTS
  The mean age of the patients was 72.6 ± 6.4 years and the mean prostate-specific antigen was 135.4 ± 290.9 ng/ml. During the first three courses of treatment, SN occurred in 72.6% of patients and FN occurred in 9.5 % of patients. Univariate analysis demonstrated that age ≥ 75 years (p = 0.002), number of comorbidities ≥ 1.2 (p = 0.008 and p = 0.006) and previous external beam radiation therapy (EBRT) (p = 0.001) were predictive factors for the development of SN or FN. In multivariate analysis, significant predictors of SN or FN were age ≥ 75 years (hazard ratio [HR] 5.77; p = 0.004) and previous EBRT (HR 14.5; p = 0.012). According to the subgroup analysis dividing SN and FN separately, multivariate analysis also revealed that age ≥ 75 years and previous EBRT were also significant predictors for developing SN (HR 5.09; p = 0.023, HR 12.7; p = 0.020, respectively) and for developing FN (HR 5.45; p = 0.042, HR 7.72; p = 0.015, respectively).
  
  
  CONCLUSIONS
  Patients aged ≥ 75 years and with a history of localized radiation therapy are at higher risk for significant neutropenic events and require closer surveillance.
authors.affiliation: Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Shigeta
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yazawa
authors.forename: Yota
authors.initials: Y
authors.lastname: Yasumizu
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Mizuno
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Nagata
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Shinoda
authors.forename: Shinya
authors.initials: S
authors.lastname: Morita
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology; D000077143:Docetaxel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000209:etiology; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel