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Clinical tools for oncology professionals

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MASCC febrile neutropenia risk score

Identifies patients with febrile neutropenia who are low risk for complications and may be suitable for outpatient management

Burden of illness

None/ Mild symptoms 5 points
Moderate symptoms 3 points
Severe symptoms 0 points

Hypotension

Systolic BP ≥90mmgHg 5 points
Systolic BP ≤90mmgHg 0 points

Active COPD

No 4 points
Yes 0 points

Type of cancer

Solid tumour 4 points
Haematological cancer, no prior fungal infection 4 points
Haematological cancer, prior fungal infection 0 points

Dehydration requiring IV fluid therapy

No 3 points
Yes 0 points

Status at onset of fever

Outpatient 3 points
Inpatient 0 points

Age

<60 years 2 points
≥60 years 0 points

MASCC score:

MASCC febrile neutropenia risk score

Interpretation

A score of ≥ 21 predicts a low risk of medical complication and such patients may be suitable for outpatient management with oral antibiotics2.

The MASCC (Multinational Association for Supportive Care in Cancer risk index) score is a predictive tool to assess the risk of complications in patients with chemotherapy related febrile neutropenia1.

The MASCC score was originally developed from a derivation and validation cohort of 756 and 383 patients respectively1. The score was subsequently further tested in 441 patients including 178 with a low-risk MASCC score who were treated with oral antibiotics resulting in no medical complications but 3 patients were readmitted giving an overall success rate of 96%. The MASCC score has been independently validated in multiple further studies achieving positive predictive value of between 83-98% and sensitivity between 59-95%3-7 .

Criticisms of the MASCC score are that it does not incorporate other factors known to associate with complications in febrile neutropenia. These are patients with profound neutropenia (neutrophil count < 0.1 x109 cells/L) or those expected to have prolonged duration of neutropenia of ≥ 7 days.

See also the Clinical Index of Stable febrile Neutropenia (CISNE) tool.

References:
  1. Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol Off J Am Soc Clin Oncol. 2000;18(16):3038-3051. doi:10.1200/JCO.2000.18.16.3038
  2. Klastersky J, Paesmans M, Georgala A, et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(25):4129-4134. doi:10.1200/JCO.2005.03.9909
  3. Uys A, Rapoport BL, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support care cancer Off J Multinatl Assoc Support Care Cancer. 2004;12(8):555-560. doi:10.1007/s00520-004-0614-5
  4. Cherif H, Johansson E, Bjorkholm M, Kalin M. The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica. 2006;91(2):215-222.
  5. Innes H, Lim SL, Hall A, Chan SY, Bhalla N, Marshall E. Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support care cancer Off J Multinatl Assoc Support Care Cancer. 2008;16(5):485-491. doi:10.1007/s00520-007-0334-8
  6. Baskaran ND, Gan GG, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol. 2008;87(7):563-569. doi:10.1007/s00277-008-0487-7
  7. Carmona-Bayonas A, Gómez J, González-Billalabeitia E, et al. Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. Br J Cancer. 2011;105(5):612-617. doi:10.1038/bjc.2011.284