MASCC risk index (febrile neutropenia)
Identifies low-risk febrile neutropenia suitable for outpatient care
- MASCC
- Onkopedia FUO (DGHO)
Sources last checked: 2026-10-13
MASCC risk index (febrile neutropenia)
Identifies low-risk febrile neutropenia suitable for outpatient care
'Burden of illness' is a subjective global judgement. A low-risk score is necessary but not sufficient for outpatient care — the outpatient pathway also requires clinical stability and reliable access to the hospital. Validated mainly in solid tumours.
Interpretation
| < 21 — high risk | 39 % complicated course and 14 % mortality in the validation data cited by Onkopedia, which provides for inpatient IV therapy in this group. |
|---|---|
| ≥ 21 — low risk | ≈ 6 % complications, 1 % mortality. Onkopedia describes outpatient (oral) treatment as an option in this group when social circumstances and adherence allow. |
What is the MASCC risk index (febrile neutropenia)?
The MASCC risk index identifies patients with chemotherapy-induced febrile neutropenia who are at low risk of serious complications. Seven factors assessed at fever onset give up to 26 points; a score of 21 or more defines low risk. It was derived by Klastersky and colleagues in 2000 in a prospective multinational study of 756 patients and validated in a separate set.
When to use it
- At presentation with febrile neutropenia after chemotherapy
- When deciding whether oral or outpatient management might be possible
- As part of the risk assessment recommended by Onkopedia/AGIHO and ESMO febrile-neutropenia guidance
When not to use it
- In patients with sepsis, organ dysfunction or hypotension — they are high risk regardless
- As the only criterion for discharge; social situation and adherence must also be suitable
How it is calculated
| Criterion | Points |
|---|---|
| Burden of febrile neutropenia (symptoms) | |
| No or mild symptoms | 5 |
| Moderate symptoms | 3 |
| Severe symptoms or moribund | 0 |
| No hypotension (systolic BP > 90 mmHg) | +5 |
| No chronic obstructive pulmonary disease | +4 |
| Solid tumour, or haematological malignancy without previous fungal infection | +4 |
| No dehydration requiring parenteral fluids | +3 |
| Outpatient at onset of fever | +3 |
| Age < 60 years | +2 |
Clinical pearls and limitations
- 'Burden of illness' is a subjective global judgement. A low-risk score is necessary but not sufficient for outpatient care — the outpatient pathway also requires clinical stability and reliable access to the hospital. Validated mainly in solid tumours.
- 'Burden of illness' (symptoms) carries the largest weight but is a subjective judgement.
- The 'no hypotension' item means systolic blood pressure > 90 mmHg.
- In apparently stable patients with solid tumours, CISNE identifies hidden high risk better than MASCC.
- Onkopedia adds a separate checklist (living situation, travel time, adherence) before outpatient treatment.
Frequently asked questions
What MASCC score is low risk?
21 or more out of 26. In validation, a score ≥ 21 identified low-risk patients with a positive predictive value of 91 %.
Can MASCC low-risk patients be treated at home?
Onkopedia describes oral, outpatient treatment as an option for low-risk patients who are clinically stable, adherent and able to return quickly; local protocols set the criteria.
MASCC or CISNE?
MASCC is the established general tool. CISNE was built for outpatients with solid tumours who look stable, and outperformed MASCC in that group.
Evidence and guidelines
- Primary source: 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 2000;18(16):3038-3051.
- Onkopedia (DGHO/AGIHO): Fieber unklarer Genese (FUO) bei neutropenischen Patienten — Tabelle 3, MASCC-Score; outpatient algorithm for MASCC ≥ 21.
- Klastersky J et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol 2016;27(suppl 5):v111-v118.
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