{"entity":{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","aka":["neutropenic fever","neutropenic sepsis","febrile neutropaenia","FN rate","neutropenic infection","infection during neutropenia"],"tldr":"Fever in a patient whose infection-fighting white cells have been wiped out by chemotherapy. It is a medical emergency: without immune cells, an ordinary infection can become fatal in hours, so antibiotics are started immediately.","summary":"Defined as temperature ≥38.3°C (or ≥38.0°C sustained) with neutrophils <0.5 × 10⁹/L, it occurs in 10-20% of patients on standard chemotherapy regimens (higher with docetaxel-based, dose-dense and induction chemotherapy), carries 5-10% mortality and is a leading cause of unplanned admission. Management is empirical broad-spectrum antibiotics within an hour, risk-scored (MASCC) to allow oral outpatient treatment for low-risk cases. Prevention with G-CSF (filgrastim, pegfilgrastim) is recommended when a regimen's risk exceeds 20%, and febrile neutropenia is a standard dose-limiting toxicity and reason for dose reduction.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Febrile_neutropenia","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Febrile_neutropenia"},{"label":"Macmillan: sepsis","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis"},{"label":"NHS: sepsis","url":"https://www.nhs.uk/conditions/sepsis/"},{"label":"NICE CG151: neutropenic sepsis","url":"https://www.nice.org.uk/guidance/cg151"},{"label":"Lymphoma Action: neutropenia (low neutrophils)","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/neutropenia-low-neutrophils"}],"tags":[],"related":["neutropenia","dose-limiting-toxicity","dose-modification","cytopenias"],"cancers":["tnbc","pancreatic","colorectal","non-hodgkin-lymphoma","dlbcl","follicular-lymphoma","mantle-cell-lymphoma","marginal-zone-lymphoma","malt-lymphoma","splenic-marginal-zone-lymphoma","nodal-marginal-zone-lymphoma","waldenstrom","primary-mediastinal-b-cell-lymphoma","burkitt-lymphoma","hodgkin-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","relapsed-refractory-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","peripheral-t-cell-lymphoma","angioimmunoblastic-t-cell-lymphoma","cutaneous-t-cell-lymphoma","sezary-syndrome","primary-cns-lymphoma"],"sections":["supportive-care"],"technologies":["g-csf-growth-factors"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Triple-negative breast cancer: the NHS says call 999 or go to A&E if an adult is breathing very fast, is confused or slurring, has blue, pale or blotchy skin, has a very high or very low temperature or is shivery, or has a rash that does not fade when pressed, and not to drive yourself. Macmillan's earlier signs to ring the 24-hour line: temperature over 37.5 C or below 36 C, shivering, or symptoms of a urine, chest, skin or tooth infection.","Pancreatic cancer chemotherapy: the NHS says call 999 or go to A&E for breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed. A blocked bile duct or stent is a second route to sepsis in this cancer, so fever counts even when the blood count is normal.","Bowel cancer chemotherapy: the NHS says to call 999 or go to A&E for breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed. A stoma is a second route to dehydration and infection in this cancer, so fever with a high stoma output counts twice.","Lymphoma: Lymphoma Action says a common sign of neutropenic sepsis is a temperature above 38 degrees Celsius, and that it is possible to have neutropenic sepsis without a fever, sometimes called cold sepsis, which steroid treatment makes more likely because steroids can mask a fever. For that reason teams also use heart rate, blood pressure, breathing rate and kidney and liver function to check for it. Steroids are part of almost every lymphoma regimen, so the no-fever presentation is not a rarity here."],"category":"Side effects"},"route":"/terms/febrile-neutropenia/","neighbours":{"term":[{"id":"carers-breast-cancer-uk","kind":"term","name":"Carers: what you can do and UK carer support (breast cancer)","route":"/terms/carers-breast-cancer-uk/"},{"id":"cytopenias","kind":"term","name":"Cytopenias and myelosuppression","route":"/terms/cytopenias/"},{"id":"dose-modification","kind":"term","name":"Dose reduction, interruption and discontinuation","route":"/terms/dose-modification/"},{"id":"dose-limiting-toxicity","kind":"term","name":"Dose-limiting toxicity (DLT)","route":"/terms/dose-limiting-toxicity/"},{"id":"hypogammaglobulinaemia","kind":"term","name":"Hypogammaglobulinaemia and infection risk after B-cell therapies","route":"/terms/hypogammaglobulinaemia/"},{"id":"lymphoma-tx-pjp-and-infection-prophylaxis","kind":"term","name":"Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination","route":"/terms/lymphoma-tx-pjp-and-infection-prophylaxis/"},{"id":"chemotherapy-side-effects-pancreatic","kind":"term","name":"Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel","route":"/terms/chemotherapy-side-effects-pancreatic/"},{"id":"chemotherapy-side-effects-colorectal","kind":"term","name":"Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies","route":"/terms/chemotherapy-side-effects-colorectal/"},{"id":"lymphoma-living-infection-years-after","kind":"term","name":"Low antibodies and infection risk for years after anti-CD20 and bispecific antibodies","route":"/terms/lymphoma-living-infection-years-after/"},{"id":"neutropenia","kind":"term","name":"Neutropenia","route":"/terms/neutropenia/"},{"id":"neutropenic-sepsis-breast-chemotherapy","kind":"term","name":"Neutropenic sepsis: the temperature rule and the 999 signs","route":"/terms/neutropenic-sepsis-breast-chemotherapy/"},{"id":"urgent-help-bowel-cancer","kind":"term","name":"When to seek urgent help with bowel cancer (NHS 111 and 999)","route":"/terms/urgent-help-bowel-cancer/"},{"id":"urgent-help-pancreatic-cancer","kind":"term","name":"When to seek urgent help with pancreatic cancer (NHS 111 and 999)","route":"/terms/urgent-help-pancreatic-cancer/"},{"id":"urgent-help-tnbc","kind":"term","name":"When to seek urgent help with triple-negative breast cancer (NHS 111 and 999)","route":"/terms/urgent-help-tnbc/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"cutaneous-t-cell-lymphoma","kind":"cancer","name":"Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)","route":"/cancers/cutaneous-t-cell-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"sezary-syndrome","kind":"cancer","name":"Sezary syndrome","route":"/cancers/sezary-syndrome/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"g-csf-growth-factors","kind":"technology","name":"Growth factors: G-CSF and febrile neutropenia prevention","route":"/technologies/g-csf-growth-factors/"},{"id":"ugt1a1-genotyping","kind":"technology","name":"UGT1A1 genotyping before irinotecan","route":"/technologies/ugt1a1-genotyping/"}],"target":[{"id":"csf3r","kind":"target","name":"G-CSF receptor (CSF3R)","route":"/targets/csf3r/"}],"paper":[{"id":"paper-conroy-folfirinox-pancreatic-nejm-2011","kind":"paper","name":"Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)","route":"/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/"}],"company":[{"id":"evive-biotech","kind":"company","name":"Evive Biotech","route":"/companies/evive-biotech/"}]}}