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Had cisplatin and pemetrexed chemotherapy done. Noticed raised in temperature. Related?

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Oncologist, Radiation
Practicing since : 2007
Answered : 526 Questions
My husband has had cisplatin& pemetrexed (spelling?) chemo. His temperature spiked at 39.4 & has been between 38.3 & 39 for 11 days now. He is in hospital & has lost a stone in weight. His bloods have come back normal, stool sample normal ct scan normal they just can't find the infection that is causing the high temperature. He has lung cancer metasise to the bones. What other tests could he have & is it possible that the chemo itself would make his temperature so high? I am worried I may loose him to the infection before the cancer takes him. This is his second chemo.
Posted Fri, 1 Mar 2013 in Lung Cancer
Answered by Dr. Dipanjan Majumder 53 minutes later
Thanks for posting your query at XXXXXXX forum.
Clinical history of your husband suggest he has stage IV lung cancer. You have not mentioned the pathology report, probably it is adenocarcinoma lung as he is receiving pemetrexed and cisplatin.

Patients receiving chemotherapy for malignant disease are prone to get infection as they are immunocompromised. Most serious complication is Febrile neutropenia which is defined as follows-

Fever: Single oral temperature ≥38.3°C or persistent temperature ≥38.0 °C for >1 hour.

[temperature of your husband 38.3-39, last 11 days ]

Neutropenia: ANC <0.5, or ANC <1.0 and a predicted decline to <0.5 over next 48 hrs. (ANC= absolute neutrophil count)

[Your previous blood report is not mentioned so this criteria can not be assessed.]

Blood culture can not detect any organism in 20% of cases.

Can you please mention what are the antibiotic used to treat him.
As his blood reports are normal [ that means his renal function test and liver function tests are also normal ] it can be said he is in low risk category.

( for your information I just want mention that there is a scoring system called MASCC score which can predict low risk and high risk group of patient.)

Regarding management of your husband I would like to suggest
-If his ANC > 0.5;
Pulse, Blood pressure , respiratory rate are within normal limit ,
he can be treated with the same antibiotic regime for 7 days or an antifungal specially active against mold can be considered. Your doctor will guide you.

As your husband is only suffering from fever with all the other reports within normal limit, there is nothing to be worried right now.

Hope this answers your queries. I will be available for further follow up.

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