Chemotherapy induced febrile neutropenia: management and prevention.

chemotherapy remains the cornerstone of cancer therapy. In most cases bone marrow suppression represents the doselimiting toxicity of these drugs. Druginduced DNA damage at the level of bone marrow progenitor cells results in a fall in circulating neutrophil count. Patients with neutropenia are at increased risk of infection and sepsis.1 The timing of neutropenia is generally predictable; it typically lasts over a 7–14 day period with the lowest point (nadir) usually around day 10. However, there are exceptions and all patients should be considered to be at risk of sepsis if they have received chemotherapy within the last 28 days. The risk is correlated with both the absolute neutrophil count and the duration of neutropenia: a low nadir (<500/mm3) and protracted duration (>10 days) are major risk factors for impending infection.1