Outpatient Management In Febrilic Neutropenia With An Intermediary Risk Of Complications: Limitative Clinical Factors

e19511 Background: Febrile neutropenia (FN) is a severe chemotherapy side effect. According to the MASCC score, hospitalization and outpatient management are respectively recommended for high-risk (HR) and low-risk (LR) patients. We have identified patients with intermediate-risk (IR) not requiring systematic hospitalization and for whom the MASCC alone may be insufficient to determine the management strategy (hospitalization or outpatient). In this study, we identified additionnal prognosis factors which help distinction between HR and IR episodes. Methods: Prospective study about consecutive FN in solid tumor patients consulting at the emergency unit of the Gustave Roussy Institute. Collected data included demographic, clinical, biological, therapeutic and economic features, MASCC score and complications. A logistic regression was performed to identify prognosis factors. Results: 137 FN were recorded for 128 patients. Twenty-six FN (18%) were managed at home (MASCC≥20). One hundred and eleven (82%) FN led to hospitalization (MASCC<20 or > 20 with clinical symptoms). Symptoms grade allowed distinction into 2 subgroups: HR (n=37) vs. IR (n=74). In IR group, 10 patients were >70 years, 41 had metastasis, 9 received third-line chemotherapy and 45 had 1-2 WHO status. Main symptoms were fever>C‘>39°C (n=19), mucitis (n=15), diarrhea (n=7), urinary symptoms (n=4), cough without anomaly in x-ray chest (n=7) and CRP>100 (n=28). MASCC was between 16 and 26 (23/74 with MASCC<21). No complications were observed in IR patients. According to the logistical analysis, FN with a 3-4 status for diarrhea or mucitis, urinary symptoms, MASCC<21 or fever>C‘>39°C must be hospitalized. Conversely, age>70 years, metastasis, shiver, chemotherapy line>3, CRP>100, presence of cough or moderate clinical symptoms (1-2) have not emerged as HR factors. In this study, 11/23 and 37/51 episodes without HR factors and a MASCC respectively <21 and ≥21 would beneficiate of an outpatient management, leading to a reduction of 58% of hospitalization costs (4486€/episode). Conclusions: This study defined an IR group, for which the MASCC additional to prognosis factors allow to determine if the hospitalization is required. No significant financial relationships to disclose.