Malaria parasitemia associated with febrile neutropenia in African patients undergoing chemotherapy for haematological malignancies. A report of three patients.

BACKGROUND: Very little is documented in the medical literature on the association between malaria parasitemia and febrile neutropenia in patients undergoing cancer chemotherapy. METHODS: This report will concentrate on the clinical presentation and outcome of 3 patients with haematological malignancies undergoing chemotherapy who developed febrile neutropenia and malaria parasitemia concurrently. RESULTS: Three patients infected with documented malaria during a febrile neutropenic episode are presented. Two patients (1 with Hodgkin's disease and the other with non-Hodgkin's lymphoma) were successfully treated and are alive after a follow-up period of 120 and 90 months, respectively. A third patient with acute lymphoblastic leukaemia developed renal failure as a complicating factor of malaria and died. CONCLUSION: It is suggested that malaria should be considered as a possible cause or a complicating factor of febrile neutropenia in patients undergoing cancer chemotherapy in endemic malaria areas.

Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score.

OBJECTIVE: The objective of this study was to prospectively validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score in an attempt to accurately predict on presentation with febrile neutropenia those cancer patients who are at low- or high-risk for development of serious medical complications during the episode. PATIENTS AND METHODS: Patients who presented with febrile neutropenia during November 2000 and July 2002 were prospectively enrolled in the protocol. All patients were hospitalized until recovery or outcome of the event and were treated with broad-spectrum, empiric, intravenous antibiotic therapy. The MASCC risk-index score (based on seven independent factors present at onset of febrile neutropenia) was calculated in 64 patients with 80 febrile neutropenic episodes. Patients with a score of > or =21 were regarded as low risk; patients with a score of <21 were regarded as high risk. RESULTS: Of the 80 febrile neutropenic episodes, 58 were classified as low-risk and 22 as high-risk patients. Fifty-seven (98.3%) of the 58 low-risk patients recovered without complications, and three (13.6%) of the 22 high-risk patients did not develop medical complications. One low-risk patient developed a fungal infection but recovered completely in comparison to 11 high-risk patients (50%) who developed serious medical complications ( p<0.001). None of the low-risk patients died. However, eight (36.4%) of the 22 high-risk patients died during the febrile neutropenic episode ( p<0.001), six as a consequence of sepsis and two due to rapidly uncontrolled cancer. CONCLUSION: We correctly predicted 98.3% of low-risk patients and 86.3% of high-risk patients. This study had a positive predictive value of 98.3% and a negative predictive value of 86.4% with both a sensitivity and specificity of 95%. The MASCC risk-index score correctly identifies low- and high-risk patients at presentation with febrile neutropenia.