Aagaard et al reported the FENCE score to predict febrile neutropenia following cancer chemotherapy. The authors are from University of Copenhagen and University College London.
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) sex
(2) age
(3) cancer type
(4) disease stage
(5) serum albumin
(6) serum total bilirubin in µmol/L
(7) eGFR by CKD-EPI in mL per minute
(8) C-reactive protein in mg/L
(9) infection before chemotherapy
(10) number of chemotherapy drugs
(11) platinums
(12) non-platinum alkylating agents
(13) taxanes
(14) topoisomerase inhibitors
(15) antimetabolites
(16) Vinca alkaloids
(17) other chemotherapy
|
Parameter |
Finding |
Points |
|
sex |
male |
0 |
|
|
female |
8 |
|
age |
< 65 years |
0 |
|
|
65 to 74 years |
9 |
|
|
>= 75 years |
4 |
|
cancer type |
gastric |
0 |
|
|
brain |
-22 |
|
|
head and neck |
52 |
|
|
esophageal |
46 |
|
|
breast |
32 |
|
|
mesothelioma |
28 |
|
|
non-small cell lung |
47 |
|
|
small cell lung |
75 |
|
|
colorectal |
-23 |
|
|
ovarian |
28 |
|
|
cervical or endometrial |
-33 |
|
|
bladder |
29 |
|
|
prostate |
6 |
|
|
testicular |
85 |
|
|
neuroendocrine |
55 |
|
|
lymphoma (DLBCL) |
7 |
|
|
other |
10 |
|
disease state |
Ann Arbor I or adjuvant |
0 |
|
|
Ann Arbor II or neoadjuvant or concomitant |
-11 |
|
|
Ann Arbor III or IV, locally advanced or disseminated |
7 |
|
albumin |
less than normal |
10 |
|
|
normal |
0 |
|
|
greater than normal |
-7 |
|
|
missing |
-3 |
|
bilirubin |
< 5 µmol/L |
1 |
|
|
5 to 25 µmol/L |
0 |
|
|
> 25 µmol/L |
17 |
|
|
missing |
-29 |
|
eGFR |
< 60 mL/min |
13 |
|
|
60 to 90 mL/min |
4 |
|
|
> 90 mL/min |
0 |
|
|
missing |
19 |
|
CRP |
< 10 mg/dL |
0 |
|
|
>= 10 mg/L |
2 |
|
|
missing |
-9 |
|
infection before chemo |
no |
0 |
|
|
yes |
10 |
|
number of chemo drugs |
1 |
0 |
|
|
2 |
10 |
|
|
3 |
47 |
|
|
4 |
56 |
|
platinum |
no |
0 |
|
|
yes |
-27 |
|
non-platinum alkylating |
no |
0 |
|
|
yes |
-2 |
|
taxanes |
no |
0 |
|
|
yes |
31 |
|
topoisomerase inhibitors |
no |
0 |
|
|
yes |
-5 |
|
antimetabolites |
no |
0 |
|
|
yes |
-16 |
|
Vinca alkaloids |
no |
0 |
|
|
yes |
-4 |
|
other chemotherapy |
no |
0 |
|
|
yes |
-50 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -189
• maximum score: 245
|
Total Score |
Risk |
|
<= 16 |
low |
|
17 to 35 |
intermediate |
|
36 to 52 |
high |
|
>= 53 |
very high |
Performance:
• The area under the ROC curve is 0.79.
Specialty: Hematology Oncology
