ABSTRACT
GOALS OF WORK: This is a prospective and observational study comparing the efficacy of risk-assessment models in patients with neutropenic fever in a reference treatment center. The meaning of the complex infection was evaluated. MATERIALS AND METHODS: Patients were recruited throughout a 9-month period. Inclusion criteria were histologic diagnosis of malignancy, neutropenic febrile secondary to chemotherapy and/or radiotherapy (absolute neutrophil count of <500/microl and axillary temperature > or = 38 degrees C), and > or = 18 years of age. MAIN RESULTS: Fifty-three febrile neutropenic patients were included. Twenty one of them were classified as low risk by the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the MASCC risk-index scores were, respectively 87.9, 85.0, 90.6, 80.9, and 86.8%. None of the low-risk patients died, but four patients classified as low risk by the MASCC model developed serious medical complications during febrile neutropenic episodes. When we subtracted patients with complex infections from the group of patients with the MASCC risk-index score of > or = 21, we got 15 patients that were classified as low risk by a proposed adjustment by complex infection (PACI) model. None of them developed serious medical complications. The sensitivity, specificity, PPV, NPV, and the accuracy of this new model were, respectively, 100, 75.0, 86.8, 100, and 90.6%. CONCLUSION: The MASCC risk-index score had high sensitivity and specificity to predict the absence of complications, but the PACI model was better than MASCC for predicting the absence of complications in this febrile neutropenic patients.
Subject(s)
Fever/etiology , Health Status Indicators , Infections/etiology , Neoplasms/therapy , Neutropenia/etiology , Anti-Bacterial Agents/therapeutic use , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Female , Fever/physiopathology , Humans , Infections/drug therapy , Male , Middle Aged , Neutropenia/physiopathology , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Sensitivity and SpecificityABSTRACT
Amifostina é um agente pancitoprotetor seletivo que protege os teci- dos normais, mas não os tumorais, contra os danos citotóxicos induzidos pela quimioterapia e irradiação ionizante. Trata-se de pró- droga que requer defosforilação pela fosfatase alcalina da membrana celular dos tecidos para formação de seu principal metobólito, o WR- 1065, o qual é imediatamente captado pelos tecidos normais, com resultante citoproteção. A droga é geralmente bem tolerada, exibindo efeitos colaterais moderados e transitórios. É o pancitoprotetor seletivo que reúne o maior banco de dados pré-clínicos.
Amifostine is a selective pancytoprotective agent that protects normal, but not maligmant tissues, from the cytotoxic damage induced by chemotherapy and irradiation therapy. It is a pro- drug that requires dephosphorilation at the tissue site by mem- brane-bound alkaline phosphatase in order to produce its main Amifostine is a selective pancytoprotective agent that protects normal, but not maligmant tissues, from the cytotoxic damage active metabolite, WR-I065, which is immediately taken up by the normal tissues, resulring in cytoprotection. The drug is usually well tolerated, with moderate and transient side-effects. To date, amifostine is the selective pancytoprotective agent with the largest preclinical databases.
