title: The time has come for new models in febrile neutropenia: a practical demonstration of the inadequacy of the MASCC score.
abstract: Since its publication more than 15 years ago, the MASCC score has been internationally validated any number of times and recommended by most clinical practice guidelines for the management of febrile neutropenia (FN) around the world. We have used an empirical data-supported simulated scenario to demonstrate that, despite everything, the MASCC score is impractical as a basis for decision-making. A detailed analysis of reasons supporting the clinical irrelevance of this model is performed. First, seven of its eight variables are "innocent bystanders" that contribute little to selecting low-risk candidates for ambulatory management. Secondly, the training series was hardly representative of outpatients with solid tumors and low-risk FN. Finally, the simultaneous inclusion of key variables both in the model and in the outcome explains its successful validation in various series of patients. Alternative methods of prognostic classification, such as the Clinical Index of Stable Febrile Neutropenia, have been specifically validated for patients with solid tumors and should replace the MASCC model in situations of clinical uncertainty.
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain. alberto.carmonabayonas@gmail.com.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-4592-3813
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Virizuela Echaburu
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez Cánovas
authors.affiliation: Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, 30008, Murcia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ayala de la Peña
mesh_terms: D064147:Febrile Neutropenia / Q000145:classification*; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: CISNE; Febrile neutropenia; Home treatment; MASCC; Outpatient; Risk