CLINICAL AND EMERGENCY APPROACHES TO FEBRILE NEUTROPENIA IN ADULTS: AN INTEGRATIVE LITERATURE REVIEW

• DOI: https://doi.org/10.22533/at.ed.0159672604067

• Palavras-chave: Chemotherapy-Induced Febrile Neutropenia; Febrile Neutropenia; Clinical Management; Granulocyte Colony-Stimulating Factor; Septic Shock; Clinical Guideline.

• Keywords: Chemotherapy-Induced Febrile Neutropenia; Febrile Neutropenia; Clinical Management; Granulocyte Colony-Stimulating Factor; Septic Shock; Clinical Guideline.

• Abstract:

  To identify and analyze the clinical and emergency strategies used in the management of febrile neutropenia (FN) in adult patients with solid tumors undergoing myelosuppressive chemotherapy, as well as their clinical and economic outcomes. Method: This is an integrative literature review, guided by the PICO strategy, with a systematic search of the PubMed, Web of Science, and LILACS databases, as well as the official ASCO and ESMO websites, covering publications from 2016 to 2026. After applying eligibility criteria and screening by two independent reviewers using the PRISMA 2020 flowchart, 29 studies were included, comprising clinical guidelines, observational and cohort studies, as well as a bundle of measures. Results: Risk stratification based on the CISNE score proved superior to the MASCC for patients with clinically stable solid tumors, favoring safe discharge. Procalcitonin (PCT > 0.5 ng/mL) and MR-proADM stood out as precision biomarkers for occult bacteremia and prediction of organ failure, respectively. Continuous prophylaxis with pegfilgrastim or biosimilar G-CSF reduced the incidence of NF from 24.1% to 1.8%, with equivalence in efficacy and safety compared to the reference drug. Sepsis, identified as a high-mortality outcome (22.2%), occurred at a median of 12.5 hours after the onset of fever, reinforcing the importance of antibiotic intervention during the “golden hour.” Hospitalization occurred in 91.2% of cases, with an average cost of $26,868 for inpatient care versus $7,738 for outpatient care. Conclusion: Effective management of CFN in solid tumors requires the integration of rigorous biological stratification, early empirical antibiotic therapy, and continuous prophylaxis with G-CSF. Patient education regarding at-home warning signs is an essential component for treatment safety and the continuity of the chemotherapy regimen.