The reliability of FEbrile Neutropenia after ChEmotherapy (FENCE) scores in predicting granulocyte colony-stimulating factor breakthrough febrile neutropenia among patients with lymphoma undergoing first-cycle chemotherapy: A prospective observational study

Abstract

Background: A tool for estimating risk of febrile neutropenia (FN) after chemotherapy, namely the FEbrile Neutropenia after ChEmotherapy (FENCE) score, has been developed but has not been widely validated. This study aimed to validate the FENCE score as a tool for predicting granulocyte colony-stimulating factor (G-CSF) breakthrough FN among patients with lymphoma who underwent chemotherapy. Methods: This was a prospective observational study of treatment-naive adult patients with lymphoma who underwent their first cycle of chemotherapy between 2020 and 2021. The patients were followed up until the next cycle of chemotherapy to identify any infection events. Results: Among the 135 patients with lymphoma, 62 (50%) were men. In a comparison of the value of each FENCE parameter for predicting G-CSF breakthrough infection, the parameter of advanced-stage disease showed high sensitivity of 92.8%, and receipt of platinum chemotherapy showed high specificity of 95.33%. With a FENCE score of 12 as a cutoff for low risk, analysis across all patients with lymphoma resulted in a high AUROCC of 0.63 (95% CI = 0.5–0.74%; p = 0.059), and analysis across only patients with diffuse large B-cell lymphoma (DLBCL) resulted in an AUROCC of 0.65 (95% CI = 0.51–0.79%; p = 0.046). With a cutoff point of 12, FENCE score can predict breakthrough infection events at 30.0% (95% CI = 17.8–47.4%). Conclusion: This study divided patients with lymphoma into risk groups according to FENCE score, showing that this instrument has discriminatory ability in predicting FN events, these being more likely to occur in patients in the intermediate- and high-risk groups. Multicenter studies are needed to validate this clinical risk score.