Aagaard et al reported the CSR-FENCE score to predict febrile neutropenia during cycle 2 to 6 of cancer chemotherapy. The authors are from University of Copenhagen and University College London.
CSR = cycle-specific risk
FENCE = FEbrile Neutropenia after ChEmotherapy
Febrile neutropenia is defined as a blood culture (positive or negative) or death within 3 days of a neutrophil count less than 500 per microliter.
Parameters:
(1) FENCE group
(2) chemotherapy with platinum
(3) chemotherapy with taxane
(4) radiation therapy
(5) cycle number
(6) neutropenia or febrile neutropenia in previous cycles
(7) G-CSF prophylaxis
Parameter
Finding
Points
FENCE group
low risk
0
intermediate risk
4
high risk
4
very high risk
5
platinum agent
no
0
yes
1
taxane agent
no
0
yes
1
radiation therapy
no
0
yes
3
cycle number
2
0
3
-1
4
-1
5
-2
6
-2
neutropenia previous cycle
no
0
neutropenia but not febrile
2
1 febrile neutropenia event
6
2 or more febrile neutropenia events
8
G-CSF prophylaxis
no
0
yes
-1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3
• maximum score: 18
Total Score
Risk Febrile Neutropenia
< 1
low
1 to 4
intermediate
5 or 6
high
>= 7
very high
Performance:
• The area under the ROC curve is 0.78 in the derivation and 0.75 in the validation cohorts.
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