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Published on: July 31, 2016
Melphalan Febrile Neutropenia Risk Factors
Masahiro Yasuda1, Tomoya Tachi, Tomohiro Osawa
1Dept. of Pharmacy, Gifu Municipal Hospital.
Abstract:
This study aimed to identify the risk factors of febrile neutropenia(FN)onset associated with melphalan(L-PAM)therapy. Thirty-nine patients(21 men, 18 women)were administered L-PAM intravenously for multiple myeloma(MM)from April 2011 to February 2022 at the Department of Hematology of Gifu Municipal Hospital. Patients were classified into those with and without FN(Grade 3 or higher), complete blood count and liver function tests were performed immediately before starting therapy. Univariate analysis with Fisher's exact probability test was performed. Factors with p<0.2 were considered as independent variables for multivariate analysis in the multiple logistic regression analysis. A multivariate analysis with 2 independent variables, lactate dehydrogenase(LD)level>222 U/L(upper limit of the facility reference value)and white <3.3×103/μL(lower limit of the facility reference value)from the univariate analysis, and FN onset(Grade 3 or higher)as the dependent variable showed that LD level>222 U/L(odds ratio: 6.33, 95% confidence interval: 1.12-35.8, p=0.037)was a significant factor. In conclusion, patients with LD levels >222 U/L immediately before starting therapy require adequate monitoring for FN onset following L-PAM administration.
Insights
Elevated lactate dehydrogenase (LD) levels before melphalan (L-PAM) therapy significantly predict febrile neutropenia (FN) risk in multiple myeloma patients. Close monitoring is crucial for patients with LD > 222 U/L to prevent severe FN.
Area of Science:
- Hematology
- Oncology
- Clinical Pharmacology
Background:
- Febrile neutropenia (FN) is a serious complication of chemotherapy.
- Melphalan (L-PAM) is frequently used for multiple myeloma (MM).
- Identifying predictive factors for FN in L-PAM therapy is crucial for patient management.
Purpose of the Study:
- To identify risk factors for febrile neutropenia (FN) onset in patients receiving melphalan (L-PAM) therapy for multiple myeloma (MM).
Main Methods:
- Retrospective analysis of 39 multiple myeloma patients treated with L-PAM.
- Assessment of complete blood count and liver function tests prior to therapy.
- Univariate and multivariate logistic regression analyses to identify significant risk factors for FN (Grade 3 or higher).
Main Results:
- Lactate dehydrogenase (LD) level > 222 U/L prior to L-PAM therapy was identified as a significant risk factor for FN onset.
- The odds ratio for FN in patients with elevated LD levels was 6.33 (95% CI: 1.12-35.8, p=0.037).
- Low white blood cell count (<3.3×103/μL) was not a significant independent predictor in the multivariate analysis.
Conclusions:
- Patients with pre-treatment lactate dehydrogenase (LD) levels exceeding 222 U/L are at significantly higher risk of developing febrile neutropenia (FN) during melphalan (L-PAM) therapy.
- Close monitoring for FN is recommended for multiple myeloma patients with elevated LD levels before initiating L-PAM treatment.
- These findings aid in optimizing patient monitoring strategies and potentially mitigating FN complications in L-PAM treated patients.
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