Incidence and Risk Factors for Breakthrough Febrile Neutropenia in Cancer Patients Receiving Chemotherapy and Prophylactic Pegfilgrastim

Background Hematopoietic growth factors (HGFs) reduces the risk of febrile neutropenia (FN) by about 50 % in cancer patients receiving chemotherapy. However, breakthrough febrile neutropenia (BTFN) is still a potentially serious complication despite the use of HGFs. Objectives We aim to investigate the frequency of BTFN and its risk factors in Middle Eastern cancer patients receiving prophylactic pegfilgrastim after cytotoxic chemotherapy. Materials and Methods All consecutive patients with solid tumors who received pegfilgrastim either in primary or secondary prophylaxis settings from Jan 2009-Dec 2010 were retrospectively identified. Medical record (electronic and paper based) were reviewed. Incidence of BTFN was calculated as (number of episodes of BTFN/total number of injections of pegfilgrastim x 100). Following variables were analyzed using chi-square test for their association with the development of BTFN age, sex, comorbidities, stage of disease, curative vs. palliative treatment, and serum albumin. Results One hundred and eighty three patients were identified. Forty patients (21.9 %) developed one or more episode of BTFN. Total number of administered pegfilgrastim injections was 581. Forty nine episodes of BTFN occurred resulting in an incidence of 8.4 %. None of the above analyzed variables were found to be a significant risk factor for the development of BTFN. However, low serum albumin level showed a trend towards significance (p=.06). Conclusion Incidence of BTFN after the use of pegfilgrastim in this patient population was found to be 8.4 %. The possibility of association with low serum albumin warrants further investigation.