***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: PURPOSE To assess the feasibility of early discharge to home therapy with st and ard intravenous antibiotics in 30 patients with fever and neutropenia at low risk by a vali date d clinical decision rule . PATIENTS AND METHODS Newly admitted out patients with fever and neutropenia were evaluated for home therapy during 2 days of inpatient observation . To evaluate enrolled patients ' acceptance of home care , we assessed patient attitudes and quality of life before and after home therapy . To assess economic effects , we compared the medical charges of patients treated at home with those of medically eligible patients who remained in the hospital . RESULTS Of the first 84 patients , 50 ( 60 % ) were medically ineligible , and neutropenia was resolved in another eight ( 10 % ) during the observation period . Only nine patients of the remaining 26 who were medically eligible ( 35 % ) were enrolled in the home-therapy trial . Thereafter , 21 of 31 medically eligible patients ( 68 % ) were enrolled . The 30 patients treated at home were neutropenic for a median of 6 days ( mean , 8.2 ) . Four had medical complications , and five others were readmitted for observation . Patients ' quality of life improved during home therapy , and favorable attitudes toward home care persisted after treatment . Medically eligible patients not enrolled had briefer neutropenia than patients treated at home , but had 44 % higher daily medical charges and equivalent overall charges despite treatment half as long . CONCLUSION We conclude that early discharge of low-risk patients to home intravenous antibiotic therapy is feasible , is well received by patients , and may prove to be cost-saving . However , these conclusions must be vali date d in a large r and omized trial Background . Hospitalization and intravenous ( IV ) broad‐spectrum antibiotics are the st and ard of care for all febrile neutropenic patients with cancer . Recent work suggests that a low‐risk population exists who might benefit from an alternate approach The effect of granulocyte colony-stimulating factor ( G-CSF ) on neutropenia , infection , and cytotoxic chemotherapy administration was studied in a r and omized trial in patients receiving intensive weekly chemotherapy for non-Hodgkin 's lymphoma ( NHL ) . Eighty patients ( aged 16 to 71 years ) with high- grade NHL ( Kiel ) of any stage were r and omized to receive VAPEC-B chemotherapy alone ( 39 patients ) or with G-CSF administered as a daily subcutaneous dose of 230 micrograms/m2 ( 41 patients ) .  Prophylactic ketoconazole and cotrimoxazole were administered to all patients throughout treatment . The protocol specified identical dose modification and antibiotic treatment criteria bor both groups . Neutropenia ( absolute neutrophil count [ ANC ] less than 1.0 x 10(9)/L ) occurred in 15 of 41 ( 37 % ) of the G-CSF-treated patients and in 33 of 39 ( 85 % ) of the controls , giving a relative risk for control patients of 2.31 ( 95 % confidence interval [ CI ] , [ 1.51 , 3.54 ] ; P = .00001 ) . Fever ( greater than or equal to 37.5 degrees C ) with neutropenia ( ANC less than 1.0 x 10(9)/L ) occurred in 9 of 41 ( 22 % ) of the G-CSF group and in 17 of 39 ( 44 % ) of the controls ( relative risk for control , 2.26 ; 95 % CI [ 1.01 , 5.06 ] ; P = .04 ) . There were fewer treatment delays , with shorter duration ( P = .01 ) in patients receiving G-CSF .  Chemotherapy doses were reduced in 4 of 41 ( 10 % ) of the G-CSF patients and 13 of 39 ( 33 % ) of the controls ( P = .01 ) . The dose intensity of cytotoxic chemotherapy  was significantly increased in patients receiving G-CSF ( median of 95 % in G-CSF group compared with 83 % in control patients ) . Three vascular deaths occurred in the G-CSF group . Delays in the control group most commonly result ed from neutropenia ( 19 patients , compared with 2 patients in the G-CSF-treated group , P = .000007 ) . Severe mucositis was the major dose-limiting toxicity in G-CSF-treated patients , but did not occur more frequently than in controls ( 15 patients in each group ) . Overall , patients r and omized to receive G-CSF achieved a greater dose intensity than control patients , but this did not result in significant differences in drug toxicity ( other than neutropenia ) , intravenous antibiotic usage , or hospitalization between the two groups Age is an important prognostic parameter , especially in patients with advanced high- grade non-Hodgkin 's lymphoma ( HG-NHL ) who require more intensive and extensive therapy for any possible chance of cure . We investigated the potential of granulocyte colony-stimulating factor ( G-CSF ) for reducing myelotoxicity , which is the most important dose-limiting factor for chemotherapy . Between March 1993 and June 1995 , 158 previously untreated patients 60 years and older with HG-NHL were included in a cooperative r and omized comparative trial and treated with a combination therapy including VNCOP-B ( cyclophosphamide , mitoxantrone , vincristine , etoposide , bleomycin , and prednisone ) with or without G-CSF . G-CSF was administered at 5 microg/kg/d throughout the treatment starting on day 3 of every week for 5 consecutive days . Of the 158 patients registered for the trial , 149 patients were evaluable : 77 received VNCOP-B plus G-CSF and 72 received VNCOP-B alone . The overall response rate was 81.5 % , with complete response in 59 % : 60 % in the VNCOP-B plus G-CSF group , and 58 % in the VNCOP-B group . At 30 months ( median 24 months ) , 68 % of all complete responders were alive without disease in the G-CSF group and 65 % in the control group . Neutropenia occurred in 18 out of 77 ( 23 % ) of the G-CSF treated patients and in 40 out of 72 ( 55.5 % ) of the controls ( P = .00005 ) . Clinical ly relevant infections occurred in 4 out of 77 ( 5 % ) of the G-CSF group and in 15 out of 72 ( 21 % ) of the controls ( P = .004 ) . The delivered dose intensity was higher in patients receiving G-CSF ( 95 % v 85 % ) , but the difference was not statistically significant . Our data show that VNCOP-B is a feasible and effective regimen in elderly HG-NHL patients , and that the use of G-CSF reduces infection and neutropenia rates without producing any significant modifications to the dose intensity , CR rate , and relapse-free survival curve PURPOSE Febrile neutropenia remains a potentially life-threatening complication of anticancer chemotherapy , but some patients are at low risk for serious medical complications . The purpose of this study was to develop an internationally vali date d scoring system to identify these patients . MATERIAL S AND METHODS Febrile neutropenic cancer patients were observed in a prospect i ve multinational study . Independent factors assessable at fever onset , predicting low risk of complications , on a r and omly selected derivation set , were assigned integer weights to develop a risk-index score , which was subsequently tested on a validation set . RESULTS On the derivation set ( 756 patients ) , predictive factors were a burden of illness indicating absence of symptoms or mild symptoms ( weight , 5 ; odds ratio [ OR ] , 8.21 ; 95 % confidence interval [ CI ] , 4.15 to 16.38 ) or moderate symptoms ( weight , 3 ; OR , 3.70 ; 95 % CI , 2.18 to 6.29 ) ; absence of hypotension ( weight , 5 ; OR , 7.62 ; 95 % CI , 2.91 to 19.89 ) ; absence of chronic obstructive pulmonary disease ( weight , 4 ; OR , 5 . 35 ; 95 % CI , 1.86 to 15.46 ) ; presence of solid tumor or absence of previous fungal infection in patients with hematologic malignancies  ( weight , 4 ; OR , 5.07 ; 95 % CI , 1.97 to 12.95 ) ;  outpatient status  ( weight , 3 ; OR , 3.51 ; 95 % CI , 2.02 to 6.04 ) ; absence of dehydration ( weight , 3 ; OR , 3.81 ; 95 % CI , 1.89 to 7.73 ) ; and age less than 60 years ( weight , 2 ; OR , 2.45 ; 95 % CI , 1.51 to 4.01 ) . On the validation set , a Multinational Association for Supportive Care in Cancer risk-index score > /= 21 identified low-risk patients with a positive predictive value of 91 % , specificity of 68 % , and sensitivity of 71 % . CONCLUSION The risk index accurately identifies patients at low risk for complications and may be used to select patients for testing therapeutic strategies that may be more convenient or cost-effective The results of a prospect i ve trial of an 8 week treatment for elderly patients with advanced intermediate-high grade NHL are reported . Our aim was to reduce general toxicity without losing an antilymphoma effect . For this reason the use of growth factor was studied . We also analysed the behavior of different histological groups ( E + F vs G + H ) . From November 1991 to November 1993 100 patients older than 65 years with combination intermediate-high grade advanced stage NHL were treated with the P-VEBEC regimen , an original including epirubicin 50 mg/sqm , cyclophosphamide 300 mg/sqm and etoposide 100 mg/sqm on weeks 1 , 3 , 5 , 7 ; vinblastine 5 mg/sqm and bleomycin 5 mg/sqm on weeks 2 , 4 , 6 , 8 ; prednisone 50 mg/sqm/day per os in the first two weeks and thereafter every other day .46 pts received rG-CSF 5 micrograms/Kg/day throughout the treatment starting on day 2 of every week for 4 consecutive days . Twenty eight pts had B symptoms , 41 had bulky disease , 37 LDH levels above normal , 50 stage IV patients and 30 had bone marrow involvement . Sixty two percent achieved a complete remission ( CR ) . Adverse prognostic factors for CR were E and F histology , stage IV disease , bone marrow infiltration , serum LDH levels above normal , international Prognostic Index ( I.I. ) intermediate-high and high risk categories and relative dose intensity ( RDI ) less than 0.80 . Severe toxicity was rarely recorded and only one toxic death was observed . With a median follow-up of 33 months OS , DFS and EFS were 44 % , 60 % and 30 % respectively . EFS was influenced by stage , BM involvement , level of LDH and I.I. intermediate-high and high risks . The 52 patients with DLCL ( diffuse large cell lymphomas -- G + H according to WF ) did better with a higher CR , OS , DFS and EFS rates , than the other WF subtypes . In conclusion P-VEBEC is a feasible combination to use in elderly patients , mainly in DLCL . The use of rG-CSF improves the RDI . A RDI > 0.80 could play a role in improving the outcome , especially in patients with adverse prognostic factors . For other subgroups another schedule is probably justified PURPOSE We report the results of a r and omized study of the European Organization for Research and Treatment of Cancer ( EORTC ) Lymphoma Group , which compared a chemotherapy regimen specifically devised for elderly patients , ie , etoposide , mitoxantrone , and prednimustine ( VMP ) , versus the st and ard regimen of cyclophosphamide , doxorobucin , vincristine , and prednisone ( CHOP ) in patients older than 70 years of age with intermediate- and high- grade non-Hodgkin 's lymphoma ( NHL ) . PATIENTS AND METHODS Patients older than 70 years of age with stage II , III , or IV intermediate- and high- grade NHL , with an Eastern Cooperative Oncology Group ( ECOG ) performance status less than 4 and acceptable cardiac , renal , and liver function were r and omized to receive six courses of VMP or six courses of CHOP .  Between February 1989 and June 1994 , 130 patients aged 70 to 93 years ( median , 75 ) were enrolled and 120 were assessable for response , 60 patients in each arm . RESULTS Overall objective response rates were 50 % and 77 % in VMP- and CHOP-treated patients , respectively ( P = .01 ) , while complete response ( CR ) rates were borderline significant ( 27 % v 45 % ; P = .06 ) . At 2 years , the progression-free survival ( PFS ) rate was 25 % with VMP versus  
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RESULTS The risk of FN associated with st and ard regimens increases with age and appears to be greatest during the first cycle of chemotherapy .
The risk of mortality associated with hospitalization with FN also increases with age but is largely associated with the higher rate of comorbidities observed in the elderly population .
Despite increasing evidence that elderly patients experience similar benefit from cancer chemotherapy , reductions in dose intensity often compromise response rates and long-term survival .
The hematopoietic growth factors reduce the risk of neutropenic events and the need for reduced dose intensity in elderly cancer patients .
Primary prophylaxis with colony-stimulating factors ( CSFs ) reduces the risk of FN and its complications in elderly patients receiving moderately intensive systemic chemotherapy for responsive malignancies .
CSFs also appear to reduce cost and improve quality of life in selected elderly patients receiving chemotherapy .