passages: 1443
passages: document
passages: Identifying patients at high risk for neutropenic complications during chemotherapy for metastatic breast cancer with doxorubicin or pegylated liposomal doxorubicin : the development of a prediction model . OBJECTIVE To develop a cycle-based risk prediction model for neutropenic complications ( NC ) during chemotherapy with doxorubicin ( DOX ) or a pegylated liposomal formulation ( PLD ) for patients with metastatic breast cancer ( MBC ) . METHODS Data analyzed was from a phase III , randomized clinical trial of DOX ( 60 mg/m ( 2 ) every 3 weeks ) or PLD ( 50 mg/m ( 2 ) every 4 weeks ) for the first line therapy for MBC ( n = 509 ) ( O'Brien et al , Ann Oncol . 2004 ; 15:440-449 ) . NC were defined as an absolute neutrophil count < or =1.5 x 10 ( 9 ) cells/L ( ie , > or =grade II ) before the next cycle , febrile neutropenia or neutropenia with a documented infection . Patient and hematologic factors potentially associated with NC were evaluated . Factors with a P value of < or =0.25 within a cycle were included in a generalized estimating equations regression model . Using backward elimination , we derived a risk scoring algorithm ( range 0-63 ) from the final reduced model . RESULTS Risk factors retained in the model included poor performance status , absolute neutrophil count < or =2.0 x 10 ( 9 ) cells/L in the previous cycle , the first cycle of chemotherapy , DOX versus PLD and advanced age . A precycle risk score from > or =25 to < 40 for a given patient was identified as being the optimal threshold for sensitivity ( 58.0 % ) and specificity ( 78.7 % ) . Patients with a score at or beyond this threshold would be considered at high risk for developing NC in later cycles . CONCLUSION The use of this model may enhance patient care by targeting preventative therapies ( eg , granulocyte colony stimulating factor or PLD ) to those MBC patients most likely to experience NC during anthracycline-based chemotherapy .
entities: 1444
entities: Intervention_Pharmacological
entities: doxorubicin
entities: 1445
entities: Intervention_Pharmacological
entities: pegylated liposomal doxorubicin
entities: 1446
entities: Intervention_Pharmacological
entities: doxorubicin ( DOX )
entities: 1447
entities: Intervention_Pharmacological
entities: pegylated liposomal formulation ( PLD )
entities: 1448
entities: Intervention_Pharmacological
entities: DOX
entities: 1449
entities: Intervention_Pharmacological
entities: PLD
entities: 1450
entities: Intervention_Pharmacological
entities: DOX
entities: 1451
entities: Intervention_Pharmacological
entities: PLD
entities: 1452
entities: Outcome_Physical
entities: neutropenic complications
entities: 1453
entities: Outcome_Physical
entities: neutropenic complications ( NC )
entities: 1454
entities: Outcome_Physical
entities: NC
entities: 1455
entities: Outcome_Physical
entities: absolute neutrophil count < or =1.5 x 10 ( 9 ) cells/L
entities: 1456
entities: Outcome_Physical
entities: febrile neutropenia or neutropenia with a documented infection .
entities: 1457
entities: Outcome_Physical
entities: poor performance status , absolute neutrophil count < or =2.0 x 10 ( 9 ) cells/L
entities: 1458
entities: Outcome_Physical
entities: age
entities: 1459
entities: Outcome_Physical
entities: precycle risk score
entities: 1460
entities: Outcome_Physical
entities: risk
entities: 1461
entities: Outcome_Physical
entities: NC
entities: 1462
entities: Participant_Condition
entities: metastatic breast cancer
entities: 1463
entities: Participant_Condition
entities: patients with metastatic breast cancer ( MBC ) .
entities: 1464
entities: Participant_Condition
entities: patients