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We are grateful for the opportunity to respond to the letter regarding our recent article1 concerning the risk assessment of neutropenic patients with fever and pulmonary infiltrates.

Drs. von Lilienfeld-Toal and Glasmacher were surprised we did not consider performance status as a possible prognostic factor able to predict patient outcome in our study population. In a retrospective study, they found Karnofsky performance status (KPS), as measured at the time of hospital admission, to be a significant prognostic factor in neutropenic febrile patients with pulmonary infiltrates. We agree with them with regard to the predictive role of this parameter in outpatients who require hospitalization but we believe that it is difficult to measure in hospitalized patients who have received chemotherapy. All these patients demonstrate signs and symptoms, require continuous care, and are confined to bed for the majority of the time, although their disabilities are different. Moreover, KPS or World Health Organization performance status can be subjective and strongly dependent on the assessment of the physician. Finally, we might consider this parameter to be similar to hypotension, shock, respiratory failure, etc., because the outcome of a patient in poor clinical condition with a high performance status is reported to be worse than that of a patient who is in better clinical condition.

In conclusion, we did not take into account performance status as prognostic factor because we did not believe it was applicable in our clinical setting.

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