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Andrès E, Mourot-Cottet R, Maloisel F, et al. History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs. J Clin Med. 2017;6(10)doi: 10.3390/jcm6100092.
Andrès, E., Mourot-Cottet, R., Maloisel, F., Keller, O., Vogel, T., Séverac, F., Tebacher, M., Gottenberg, J. E., Weber, J. C., Kaltenbach, G., Goichot, B., Sibilia, J., Korganow, A. S., & Herbrecht, R. (2017). History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs. Journal of clinical medicine, 6(10), . https://doi.org/10.3390/jcm6100092
Andrès, Emmanuel, et al. "History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs." Journal of clinical medicine vol. 6,10 (2017). doi: https://doi.org/10.3390/jcm6100092
Andrès E, Mourot-Cottet R, Maloisel F, Keller O, Vogel T, Séverac F, Tebacher M, Gottenberg JE, Weber JC, Kaltenbach G, Goichot B, Sibilia J, Korganow AS, Herbrecht R. History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs. J Clin Med. 2017 Sep 26;6(10). doi: 10.3390/jcm6100092. PMID: 28954408; PMCID: PMC5664007.
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J Clin Med. 2017 Sep 26;6(10). doi: 10.3390/jcm6100092.

History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs.

Journal of clinical medicine

Emmanuel Andrès, Rachel Mourot-Cottet, Frédéric Maloisel, Olivier Keller, Thomas Vogel, François Séverac, Martine Tebacher, Jacques-Eric Gottenberg, Jean-Christophe Weber, Georges Kaltenbach, Bernard Goichot, Jean Sibilia, Anne-Sophie Korganow, Raoul Herbrecht

Affiliations

  1. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  2. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  3. Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  4. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  5. Departments of Geriatrics, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  6. Departments of Statistics, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  7. Regional Pharmacovigilance Centre of Alsace, Strasbourg 67000, France. [email protected].
  8. Departments of Rheumatology, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  9. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  10. Departments of Geriatrics, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  11. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  12. Departments of Rheumatology, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  13. Departments of Internal, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].
  14. Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France. [email protected].

PMID: 28954408 PMCID: PMC5664007 DOI: 10.3390/jcm6100092

Abstract

BACKGROUND: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital.

PATIENTS AND METHODS: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France).

RESULTS: Mean patient age was 52.2 years old (range: 18-93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0-0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2-21), which was reduced to 0.7 days (range: 2-16) (

CONCLUSIONS: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of "daily medication" exposure.

Keywords: agranulocytosis; drug; fever; hematopoietic growth factor; infection; neutropenia

Conflict of interest statement

The authors (Rachel Mourot-Cottet, Frédéric Maloisel, Olivier Keller, François Séverac, Thomas Vogel, Martine Tebacher, Jean-Christophe Weber, Georges Kaltenbach, Jacques-Eric Gottenberg, Bernard Goic

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