Pretreatment monocyte counts and neutrophil counts predict the risk for febrile neutropenia in patients undergoing TPF chemotherapy for head and neck squamous cell carcinoma
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Marie Shimanuki1, Yorihisa Imanishi1, Yoichiro Sato1, Nana Nakahara1, Daisuke Totsuka1, Emiri Sato1, Sena Iguchi1, Yasuo Sato2, Keiko Soma3, Yasutomo Araki1, Seiji Shigetomi4, Satoko Yoshida5, Kosuke Uno6, Yusuke Ogawa7, Takehiro Tominaga5, Yuichi Ikari5, Junko Nagayama4, Ayako Endo8, Koshiro Miura9, Takuya Tomioka10, Hiroyuki Ozawa5 and Kaoru Ogawa5
1Department of Otorhinolaryngology–Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
2Department of Otorhinolaryngology, Kyosai Tachikawa Hospital, Tachikawa, Tokyo, Japan
3Department of Otorhinolaryngology, Matsumoto Dental University, Matsumoto, Nagano, Japan
4Department of Otorhinolaryngology, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa, Japan
5Department of Otorhinolaryngology–Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
6Department of Otolaryngology–Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
7Department of Otorhinolaryngology, International University of Health and Welfare Atami Hospital, Atami, Shizuoka, Japan
8Department of Otorhinolaryngology, Saitama Red Cross Hospital, Saitama, Saitama, Japan
9Department of Otorhinolaryngology, Kamio Memorial Hospital, Chiyoda, Tokyo, Japan
10Department of Otorhinolaryngology, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
Yorihisa Imanishi, email: email@example.com
Keywords: febrile neutropenia; TPF; monocyte count; neutrophil count; head and neck squamous cell carcinoma
Received: February 09, 2018 Accepted: March 07, 2018 Published: April 10, 2018
Background: Febrile neutropenia (FN) is the most serious hematologic toxicity of systemic chemotherapy. However, accurate prediction of FN development has been difficult because the risk varies largely depending on the chemotherapy regimen and various individual factors.
Methods: We retrospectively analyzed diverse clinical factors including pretreatment hematological parameters to clarify the reliable predictors of FN development during chemotherapy with a docetaxel, cisplatin, and fluorouracil (TPF) regimen in patients with head and neck squamous cell carcinoma.
Results: Among the 50 patients, grade ≥3 neutropenia, grade 4 neutropenia, and FN developed in 36 (72%), 21 (42%), and 12 (24%) patients, respectively. Multivariate logistic regression revealed that a pretreatment absolute monocyte count (AMC) <370/mm3 is an independent predictor of TPF chemotherapy-induced FN (odds ratio=6.000, p=0.017). The predictive performance of the model combining AMC and absolute neutrophil count (ANC), in which the high-risk group was defined as having an AMC <370/mm3 and/or ANC <3500/mm3, was superior (area under the curve [AUC]=0.745) to that of the model with a cutoff for AMC alone (AUC=0.679).
Conclusions: On the basis of our results, we recommend primary prophylactic use of granulocyte colony-stimulating factor and/or antibiotics selectively for patients predicted to be at high risk for TPF chemotherapy-induced FN.
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