Treating a patient with neutropenia according to his or her risk level can provide effective treatment at a lower cost for many patients. Rolston divided patients with neutropenia into 3 risk groups (low, moderate, high) and outlined treatment strategies for each group.
Criteria:
(1) absolute neutrophil count < 500 per µL
(2) temperature either (a) sustained at > 38°C for several hours or (b) single temperature > 38.3°C
|
Parameter |
Low Risk |
Moderate Risk |
High Risk |
|
duration of neutropenia |
<= 7 days |
7 – 14 days |
>= 14 days |
|
degree of absolute neutropenia |
|
|
< 100 per µL |
|
comorbidities |
none |
minimal |
substantial |
|
patient stability |
clinically stable at onset of febrile episode |
clinically stable |
unstable |
|
response to initial therapy |
good |
early response |
slow |
where:
• Comorbidities include hypotension, dehydration, renal insufficiency, hepatic insufficiency, respiratory insufficiency, altered mentation, uncontrolled bleeding, hypercalcemia, etc.
Examples of typical risk group patients:
(1) low: solid tumor with conventional therapy
(2) moderate: solid tumor with autologous bone marrow or peripheral blood stem cell transplant
(3) high: hematologic malignancy or allogeneic bone marrow transplant
|
Risk Group |
Treatment Strategies |
|
low |
outpatient antibiotic therapy |
|
moderate |
initially parenteral therapy started in the hospital, with early discharge followed by outpatient therapy |
|
high |
parenteral therapy in the hospital for the duration of the febrile episode, closer monitoring with cultures as indicated |
Limitations:
• Risk assessment and patient selection has to be done carefully.
• Appropriate antibiotic regimens need to be used.
• Patients need to be monitored carefully to response to therapy and for early detection of complications or toxicities.
Specialty: Infectious Diseases, Hematology Oncology
ICD-10: ,
