Skip to main content

Advertisement

Log in

The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

The Multinational Association for Supportive Care in Cancer risk index score developed, through a multinational collaboration, was published in 2000 with the aim to identify patients with chemotherapy-induced febrile neutropenia at low risk of serious medical complication development. It has been endorsed as a reliable tool since 2002 by Infectious Diseases Society of America. Ten years after, we thought worth to review its use, its characteristics in the external validations that occurred after the initial publication and also to review how the recognition of a group of patients at low risk has changed the management of febrile neutropenia. We also raise the issue of identification of high-risk patients that remains a challenge today.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bodey GP, Buckley M, Sathe YS et al (1996) Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–340

    Google Scholar 

  2. Schimpff S, Satterlee W, Young VM et al (1971) Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 284:161–165

    Article  Google Scholar 

  3. Klastersky J (1983) Empiric treatment of infections in neutropenic patients with cancer. Rev Infect Dis 5:S21–S23

    Article  PubMed  Google Scholar 

  4. The EORTC International Antimicrobial Therapy Cooperative Group (1978) Ceftazidime combined with a short or long course of amikacin for empirical therapy of gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 317:1692–1698

    Google Scholar 

  5. Talcott JA, Siegel RD, Finberg R et al (1992) Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol 10:316–322

    PubMed  CAS  Google Scholar 

  6. Talcott JA, Whalen A, Clark J et al (1994) Home antibiotic-therapy for low-risk cancer patients with fever and neutropenia-a pilot-study of 30 patients based on a validated prediction rule. J Clin Oncol 12:107–114

    PubMed  CAS  Google Scholar 

  7. Kern WV, Cometta A, De Bock R et al (1999) Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. N Engl J Med 314:312–318

    Article  Google Scholar 

  8. Freifeld A, Marchigiani D, Walsh T et al (1999) A double blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med 341:305–3011

    Article  PubMed  CAS  Google Scholar 

  9. Klastersky J, Paesmans M, Rubenstein EB et al (2000) The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18:3038–3051

    PubMed  CAS  Google Scholar 

  10. Naurois J, Novitzky-Basso I, Gill JM et al (2010) Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol 21:252–256

    Article  Google Scholar 

  11. Hughes WT, Amstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  12. Freifeld A, Bow E, Sepkowitz K et al (2011) Executive summary: clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by infectious diseases society of America. Clin Infect Dis 52:e56–e93

    Article  PubMed  Google Scholar 

  13. Uys A, Rapoport B, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk index score. Support Care Cancer 12:555–560

    Article  PubMed  Google Scholar 

  14. Cherif H, Johansson E, Björkholm M et al (2006) The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica 91:215–222

    PubMed  Google Scholar 

  15. Baskaran ND, Gan GG, Adeeba K (2008) Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 87:563–569

    Article  PubMed  Google Scholar 

  16. Pun Hui E, Leung KS, Poon T et al (2011) Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer 19:1625–1635

    Article  Google Scholar 

  17. Carmona-Bayonas A, Gómez J, González-Billalabeitia E et al (2011) Prognostic evaluation of febrile neutropaenia in apparently stable adult cancer patient. Br J Cancer 105:612–617

    Article  PubMed  CAS  Google Scholar 

  18. Philips R, Wade R, Lehrnbecher T et al (2012) Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer. BMC Med 10:6

    Article  Google Scholar 

  19. Paesmans M, Klastersky J, Maertens J et al (2011) Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter? Support Care Cancer 19:1001–1008

    Article  PubMed  Google Scholar 

  20. Furno P, Bucaneve G, Del Favero A (2002) Monotherapy or aminoglycoside containing combinations for empirical antibiotic treatment of febrile neutropenia patients: a meta-analysis. Lancet 2:231–243

    CAS  Google Scholar 

  21. Kridel R, Van Delden C, Calandra T et al (2008) Antibiothérapie empirique lors de neutropénie febrile. Rev Med Suisse 4:914–919

    PubMed  CAS  Google Scholar 

  22. Mebis J, Goossens H, Berneman ZN (2010) Antibiotic management of febrile neutropenia: current developments and future directions. J Chemother 22:5–12

    PubMed  CAS  Google Scholar 

  23. Event C, Taillade L, Spano JP et al (2010) Neutropénie fébrile chez le patient adulte atteint de tumeur solide: revue de la littérature pour une gestion rationnelle et optimale. Bull Cancer 97:547–557

    Google Scholar 

  24. Tam CS, O’Reilly M, Andresen D et al (2011) Use of empiric antimicrobial therapy in neutropenic fever. Intern Med J 41:90–101

    Article  PubMed  CAS  Google Scholar 

  25. Rolston K, Frisbee-Hume S, Patel S et al (2010) Oral moxifloxacin for outpatients treatment of low-risk, febrile neutropenic patients. Support Care Cancer 18:89–94

    Article  PubMed  Google Scholar 

  26. Zuckermann J, Moreira L, Stoll P (2008) Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes. Ann Hematol 87:139–145

    Article  PubMed  CAS  Google Scholar 

  27. Sebban C, Dussart S, Fuhrmann C et al (2008) Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge. Support Care Cancer 16:1017–1023

    Article  PubMed  Google Scholar 

  28. Innes HE, Smith DB, O’Reilly SM et al (2003) Oral antibiotics with early hospital discharge compared with in-patients intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomized controlled single centre study. Br J Cancer 89:43–49

    Article  PubMed  CAS  Google Scholar 

  29. Innes H, Lim S, Hall A et al (2008) Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support Care Cancer 16:485–4941

    Article  PubMed  Google Scholar 

  30. Klastersky J, Paesmans M, Georgala A et al (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24:4129–4134

    Article  PubMed  CAS  Google Scholar 

  31. Brack E, Bodmer N, Simon A et al (2012) First-day step-down to oral outpatient treatment versus continued standard treatment in children with cancer and low-risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study. Pediatr Blood Cancer 59(3):423–430. doi:10.1002/pbc.24076

    Article  PubMed  Google Scholar 

  32. Carstensen M, Sorensen JB (2008) Outpatient management of febrile neutropenia: time to revise the present treatment strategy. J Support Oncol 6:199–208

    PubMed  CAS  Google Scholar 

  33. Teuffel O, Ethier MC, Alibhal SM et al (2011) Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 22:2358–2365

    Article  PubMed  CAS  Google Scholar 

  34. Teuffel E, Amir, Alibhai S et al (2011) Cost-effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients. B JCancer 104:1377–1383

    Article  CAS  Google Scholar 

  35. Elting L, Lu C, Escalante C et al (2008) Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. J Clin Oncol 26:606–611

    Article  PubMed  Google Scholar 

  36. Talcott J, Yeap B, Clark J et al (2011) Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial. J Clin Oncol 29:3977–3988

    Article  PubMed  Google Scholar 

  37. Hendricks A, Trice Loggers E, Talcott J (2011) Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial. J Clin Oncol 29:3984–3988

    Article  PubMed  Google Scholar 

  38. Teuffel O, Cheng S, Ethier M et al (2012) Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients. Support Care Cancer 20(11):2755–2764

    Article  PubMed  CAS  Google Scholar 

  39. Diorio C, Martino J, Boydell K et al (2011) Parental perspectives on inpatient versus outpatient management of pediatric febrile neutropenia. J Pediatr Oncol Nurs 28:355–362

    Article  PubMed  Google Scholar 

  40. Manji A, Beyene J, Dupuis R et al (2012) Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials. Support Care Cancer 20:1135–1145

    Article  PubMed  CAS  Google Scholar 

  41. Sung L, Alibhai S, Ethier MC et al (2012) Discrete choice experiment produced estimates of acceptable risks of therapeutic options in cancer patients with febrile neutropenia. J Clin Epidemiol 65:627–634

    Article  PubMed  Google Scholar 

  42. Freifeld A, Sankaranarayanan J, Ullrich F et al (2008) Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA. Support Care Cancer 16:181–191

    Article  PubMed  Google Scholar 

  43. Rubenstein EB, Rolston K, Benjamin RS et al (1993) Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer 71:3640–3646

    Article  PubMed  CAS  Google Scholar 

  44. Klastersky J, Ameye L, Maertens et al (2007) Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents 30(Suppl 1):S51–S59

    Article  PubMed  CAS  Google Scholar 

  45. Blot F, Nitenberg G (2004) Patients neutropéniques fébriles à bas et haut risques. Presse Med 33:473–479

    Article  Google Scholar 

  46. Sammut S, Mazhar D (2012) Management of febrile neutropenia in an acute oncology service. Q J Med 105:327–336

    Article  CAS  Google Scholar 

  47. André S, Taboulet P, Elie C (2010) Febrile neutropenia in French emergency departments: results of a prospective multicentre survey. Crit Care 14:R68

    Article  PubMed  Google Scholar 

  48. Lim C, Bawden J, Wing A et al (2012) Febrile neutropenia in EDs: the role of an electronic clinical practice guideline. Am J Emerg Med 30(1):5, 11, 11.e1–5

    Article  PubMed  Google Scholar 

  49. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  PubMed  CAS  Google Scholar 

  50. Ahn S, Lee YS, Chun YH et al (2011) Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia. Support Care Cancer 19:1151–1158

    Article  PubMed  Google Scholar 

  51. Kim D, Lee YS, Ahn S et al (2011) The usefulness of procalcitonin and C-reactive protein as early diagnostic markers of bacteremia in cancer patients with febrile neutropenia. Cancer Res Treat 43:176–180

    Article  PubMed  Google Scholar 

  52. Uys A, Rapoport B, Meyer P et al (2007) Prediction of outcome in cancer patients with febrile neutropenia: comparison of the Multinational Association of Supportive Care in Cancer risk-index score with procalcitonin, C-reactive protein, serum amyloid A, and interleukins-1β, -6 and -10. Eur J Cancer Care (Engl) 16:475–483

    Article  CAS  Google Scholar 

  53. Mato A, Luger S, Heitjan D et al (2010) Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 h. Cancer Biol Ther 9:585–589

    Article  PubMed  CAS  Google Scholar 

  54. Jeddi R, Zarrouk M, Benabdennebi Y et al (2007) Predictive factors of septic shock and mortality in neutropenic patients. Hematology 12:543–548

    Article  Google Scholar 

  55. Shaikh AJ, Bawany SA, Masood N et al (2011) Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia. J Cancer 2:62–66

    Article  PubMed  Google Scholar 

  56. Nakagawa Y, Suzuki K, Masaoka T (2009) Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. J Infect Chemother 15:174–179

    Article  PubMed  Google Scholar 

  57. Park Y, Kim D, Park S et al (2010) The suggestion of a risk stratification system for febrile neutropenia in patients with hematologic disease. Leuk Res 34:294–300

    Article  PubMed  Google Scholar 

  58. De Souza VL, Serufo JC, da Costa Rocha MO et al (2008) Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer 16:841–846

    Article  Google Scholar 

  59. Eun Ha Y, Song JH, Kang WK et al (2011) Clinical factors predicting bacteremia in low-risk febrile neutropenia after anti-cancer chemotherapy. Support Care Cancer 19:1761–1767

    Article  Google Scholar 

  60. Lamoth F, Jaton K, Prod’hom G et al (2010) Multiplex blood PCR in combination with blood cultures for improvement of microbiological documentation of infection in febrile neutropenia. J Clin Microbiol 48:3510–3516

    Article  PubMed  CAS  Google Scholar 

  61. Vänskä M, Koivula I, Hämäläinen S et al (2011) High pentraxin 3 level predicts septic shock and bacteremia at the onset of febrile neutropenia after intensive chemotherapy of hematologic patients. Haematologica 96:1385–1389

    Article  PubMed  Google Scholar 

  62. Lyman G, Kuderer N, Crawford B et al (2011) Predicting individual risk of neutropenic complications in patients receiving cancer chemotherapy. Cancer 117:1917–1927

    Article  PubMed  Google Scholar 

  63. Moreau M, Klasterky J, Schwarzbold A et al (2009) A general chemotherapy myelotoxicity score to predict febrile neutropenia in hematological malignancies. Ann Oncol 20:513–519

    Article  PubMed  CAS  Google Scholar 

  64. Lalami Y, Paesmans M, Muanza F et al (2006) Can we predict the duration of chemotherapy-induced neutropenia in febrile neutropenic patients, focusing on regimen-specific risk factors? A retrospective analysis. Ann Oncol 17:507–514

    Article  PubMed  CAS  Google Scholar 

  65. Aapro MS, Cameron DA, Pettengell R et al (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumors. Eur J Cancer 42:2433–2453

    Article  PubMed  CAS  Google Scholar 

  66. Dale C (2009) Advances in the treatment of neutropenia. Curr Opin Support Palliat Care 3:207–212

    Article  PubMed  Google Scholar 

  67. Cooper K, Madan J, Whyte S et al (2011) Granulocyte colony-stimulating factors for febrile neutropenia prophylaxis following chemotherapy: systematic review and meta-analysis. BMC Cancer 11:404

    Article  PubMed  CAS  Google Scholar 

  68. Klastersky J, Georgala A, Ameye L et al (2010) Febrile neutropenia (FN) in patients with solid tumors (St): is the risk of complications affected by the type of chemotherapy? Support Care Cancer 18:S67–S220

    Google Scholar 

  69. Klastersky J, Awada A, Aoun M et al (2009) Should the indications for the use of myeloid growth factors for the prevention of febrile neutropenia in cancer patients be extended? Curr Opin Oncol 21:297–302

    Article  PubMed  CAS  Google Scholar 

  70. Papaldo P, López M, Marolla P et al (2005) Impact of five prophylactic filgrastim schedules on hematologic toxicity in early breast cancer patients treated with epirubicin and cyclophosphamide. J Clin Oncol 23:6908–6918

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Both authors declare that they do not have any conflict of interest in relation with the manuscript; no funding has been received for this work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marianne Paesmans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klastersky, J., Paesmans, M. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer 21, 1487–1495 (2013). https://doi.org/10.1007/s00520-013-1758-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1758-y

Keywords

Navigation