Validation of the (CSR)FENCE score for prediction of febrile neutropenia during chemotherapy cycles 2–6

PURPOSE: Though febrile neutropenia (FN) risk prediction models are important in clinical practice, their external validation is limited. In this study, we validated the Cycle-Specific Risk of FEbrile Neutropenia after ChEmotherapy ((CSR)FENCE) score for predicting FN. METHODS: We reviewed the medical records of patients with solid malignancies and diffuse large B-cell lymphoma during chemotherapy cycles 2–6 and recorded if patients developed FN, defined as absolute neutrophil counts less than 500 cells/microL with fever more than or equal to 38.2 ℃. The (CSR)FENCE score was determined by adding the risk factors' coefficients described by the original study; subsequently, the score was used to classify chemotherapy cycles into the following risk groups for developing FN: low, intermediate, high, and very high risk. The discriminatory ability of the score was assessed using area under the receiver operating characteristics curve (AUROCC) and incidence rate ratios (IRR) within each (CSR)FENCE risk group. RESULTS: We analyzed 2870 chemotherapy cycles, of which 42 (1.5%) were associated with FN. Among those, 3 (7.1%), 14 (33.3%), 5 (12%), and 20 (47.6%) were classified as low, intermediate, high, and very high risk for developing FN, respectively. The AUROCC was 0.72 (95% CI 0.64–0.81). Compared with the low risk group (n = 666), the IRR of developing FN was 1.01 (95% CI 0.15–43.37), 0.69 (95% CI 0.08–32.46) and 1.17 (95% CI 0.17–49.49) in the intermediate (n = 1431), high (n = 498) and very high (n = 275) risk groups, respectively. CONCLUSION: The (CSR)FENCE model can moderately stratify patients into four risk groups for predicting FN prior to chemotherapy cycles 2–6.