We prospectively evaluated 131 consecutive episodes of
fever and
chemotherapy-induced
neutropenia in 85 adults with haematological
malignancies to determine whether older patients (aged < 60 years) have different causes of
fever and outcome than younger adults (aged < 60 years). Patients were stratified into high-risk and low-risk groups according to previously published criteria. High-risk patients received
ceftazidime plus
amikacin and low-risk patients received
ceftazidime alone. All patients were hospitalized until
fever and
neutropenia resolved. Ninety one high-risk episodes were documented: 56 occurring in older patients (mean age 69 years) and 35 in younger adults (mean age 45 years). Non-Hodkgin's
lymphoma and acute myeloid leukaemia were the most frequent underlying
neoplasias in both age groups. Intensity of
chemotherapy was similar in both age groups. Mean neutrophil count at entry, median duration of
neutropenia, rate of documented
infection, incidence of bacteraemia, response to
therapy, overall mortality and infectious mortality were similar in the two high-risk age subgroups. The elderly subgroup had a trend to have more Gram-negative
infections and the younger patients more Gram-positive
infections. In addition, 40 low-risk episodes were registered: 29 in elderly patients (mean age 68 years) and 11 in younger patients (mean age 44 years). Elderly low-risk patients had more concurrent diseases that younger ones (P = 0.124). Mean neutrophil count at entry, median duration of severe
neutropenia and rate of response were similar in the two age subgroups. All low-risk patients survived. In conclusion, elderly haematological
cancer patients with
febrile neutropenia show similar rates of
infection and outcome to younger ones.