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MASCC Risk Index for Febrile Neutropenia

The MASCC risk index (0–26) identifies febrile neutropenic cancer patients at low risk of serious complications. A score ≥21 is low risk (candidates for oral/outpatient therapy if otherwise suitable); <21 is high risk and warrants inpatient IV antibiotics.

  • Burden of illness (symptoms): No or mild symptoms (5); Moderate symptoms (3); Severe symptoms or moribund (0)
  • Hypotension (SBP <90 mmHg) (yes/no)
  • Chronic obstructive pulmonary disease (yes/no)
  • Tumor type: Solid tumor (4); Hematologic malignancy, no previous fungal infection (4); Hematologic malignancy with previous fungal infection (0)
  • Dehydration requiring IV fluids (yes/no)
  • Inpatient at onset of fever (yes/no)
  • Age (years)
—

Interpretation

ResultMeaning
≥21Low risk of serious complications (PPV 91% in validation)
<21High risk: inpatient IV therapy

Formula

Burden of illness: none/mild 5, moderate 3, severe 0 · no hypotension (SBP ≥90) 5 · no COPD 4 · solid tumor or hematologic malignancy without prior fungal infection 4 · no dehydration requiring IV fluids 3 · outpatient at fever onset 3 · age <60 2

Clinical pearls

  • MASCC does not by itself establish outpatient eligibility: patients also need reliable follow-up, oral tolerance and quick access to care (IDSA/ASCO).
  • Burden-of-illness points are not additive: choose the single best descriptor.
  • For clinically stable solid-tumor patients, CISNE adds discrimination within the MASCC low-risk group.

Examples

mascc 45 yo breast cancer outpatient mild symptoms no hypotension no copdfebrile neutropenia risk for a 70 year old inpatient with AML and prior aspergillosis, hypotensive, severe symptomsMASCC 65M lymphoma moderate symptoms, outpatient, no copd, not dehydrated

FAQ

What MASCC score is low risk?

A MASCC score of 21 or higher (maximum 26) identifies low-risk febrile neutropenia.

Can a low-risk MASCC patient be treated as an outpatient?

Often, with oral antibiotics, if they can take oral medication, have close follow-up and can return quickly; otherwise admit.

Evidence

  1. Klastersky J 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;18:3038–51.

Infectious Disease · Reviewed 2026-10-14 · Methodology