A Proposed Score for Predicting Severe Infection Complications in Children With Chemotherapy-induced Febrile Neutropenia

Rondinelli, Patricia Imperatriz Porto; Ribeiro, Karina de Cássia Braga; Camargo, Beatriz de

doi:10.1097/01.mph.0000212996.94929.0b

Cited by 109 publications

(124 citation statements)

References 20 publications

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“…Neutropenia terjadi apabila jumlah neutrofil batang dan segmen <500/µl atau <1000/µl yang diperkirakan akan menurun menjadi <500/µl dalam 72 hari ke depan. [2][3][4] Penelitian uji diagnostik metode potong lintang retrospektif dengan membandingkan sistem skoring Rondinelli terhadap baku emas yaitu komplikasi infeksi berat berupa kondisi septikemia yang disertai bakteremia pada kultur darah. Penelitian dilakukan di Divisi Hematologi-Onkologi Departemen IKA FKUI/RSCM.…”

Section: Metodeunclassified

“…Median usia subjek adalah 4 tahun 11 bulan (1 tahun 9 bulan-17 tahun 1 bulan) dengan proporsi kelompok P asien anak dengan keganasan yang mendapatkan pengobatan kemoterapi sering mengalami episode demam neutropenia. 1,2 Penurunan jumlah neutrofil dalam sirkulasi darah merupakan komplikasi dari pemberian kemoterapi yang bersifat toksik terhadap sumsum tulang. [5][6][7] Kondisi ini akan meningkatkan risiko infeksi yang berat akibat penurunan fungsi utama neutrofil sebagai pertahanan terhadap mikroorganisme asing.…”

Section: Hasilunclassified

“…Pasien dikatakan risiko rendah apabila total skor <5,5, risiko sedang apabila skor antara 5,5 sampai 9, sedangkan lebih dari 9 dikatakan risiko tinggi. 2 Infectious Diseases Society of America (IDSA) telah menyusun pedoman penggunaan antibiotik pada pasien keganasan dengan demam neutropenia dan menggolongkan pasien tersebut menjadi dua kategori, yaitu risiko rendah dan risiko tinggi terhadap komplikasi infeksi berat seperti tertera pada algoritma (Gambar 1). usia ≤5 tahun hampir sama dengan kelompok usia >5 tahun (Tabel 2).…”

Section: 17unclassified

“…Hal tersebut sejalan dengan penelitian Rondinelli yang menyatakan bahwa anak yang berusia lebih muda dari 5 tahun saat masuk rumah sakit dengan demam neutropenia akan mempunyai risiko komplikasi infeksi berat 2,2 kali lebih besar dari yang lebih tua. 2,18,19 Malnutrisi banyak ditemukan pada anak dengan keganasan dan merupakan faktor utama yang berpengaruh terhadap rencana pengobatan lebih lanjut, besarnya komplikasi yang terjadi dan prognosis pada anak dengan keganasan. Status gizi subjek yang terbanyak pada penelitian kami adalah gizi baik.…”

Section: Pembahasanunclassified

“…Kadar hemoglobin ≤7g/dL memberikan risiko 1,9 kali lebih besar untuk terjadinya komplikasi infeksi berat pada pasien demam neutropenia selama pemberian kemoterapi. 2 Median pemeriksaan absolute neutrophil count (ANC) pada penelitian kami adalah 228/µl (18-940/µl). Penurunan ANC hingga <1000/µL akan meningkatkan kerentanan terhadap infeksi dan risiko terjadinya infeksi ini berbanding terbalik dengan nilai ANC.…”

Section: Pembahasanunclassified

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Validasi Sistem Skoring Rondinelli untuk Mendeteksi Komplikasi Infeksi Berat pada Pasien Leukemia Limfoblastik Akut L1 dengan Demam Neutropenia Selama Kemoterapi Fase Induksi

Hidayat

Gatot

Djer

2016

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Latar belakang. Anak dengan keganasan yang mendapatkan pengobatan kemoterapi sering mengalami episode demam neutropenia. Kondisi ini akan meningkatkan risiko infeksi yang berat akibat penurunan fungsi utama neutrofil sebagai pertahanan terhadap mikroorganisme asing. Rondinelli dkk telah mengusulkan suatu sistem skoring untuk memprediksikan terjadinya komplikasi infeksi berat pada pasien keganasan dengan demam neutropenia selama pemberian kemoterapi sehingga diperoleh tata laksana yang sesuai. Kata kunci: skoring Rondinelli, komplikasi infeksi berat, leukemia limfoblastik akut L1

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Section: Pembahasanunclassified

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Validasi Sistem Skoring Rondinelli untuk Mendeteksi Komplikasi Infeksi Berat pada Pasien Leukemia Limfoblastik Akut L1 dengan Demam Neutropenia Selama Kemoterapi Fase Induksi

Hidayat

Gatot

Djer

2016

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Incidence and Risk Factors for Neutropenia After Intra-Arterial Chemotherapy for Retinoblastoma

Lee,

Donkor,

Parvus

et al. 2023

JAMA Ophthalmol

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ImportanceIntra-arterial chemotherapy (IAC) has quickly gained popularity as a mainstay of treatment for retinoblastoma. Intra-articular chemotherapy has been described as having several advantages over systemic chemotherapy, including reduced systemic toxicity and neutropenia; however, studies on the risk of neutropenia after IAC remain limited.ObjectiveTo estimate the incidence of neutropenia after IAC, as well as identify risk factors associated with the development of neutropenia.Design, Setting, and ParticipantsThis case series included pediatric patients with unilateral or bilateral retinoblastoma who were treated with IAC at a single quaternary care center from July 13, 2013, to January 6, 2023.ExposureAll patients were treated with IAC and underwent multiple IAC cycles depending on treatment response. The primary chemotherapy agent used was melphalan, but topotecan or carboplatin could be used along with melphalan. Melphalan doses were kept to 0.4 mg/kg or less per cycle. After each IAC cycle, complete blood cell counts were obtained within 10 to 12 days and repeated until the absolute neutrophil count (ANC) was greater than or equal to 1000/μL.Main Outcomes and MeasuresThe primary outcome was the minimum ANC after each IAC cycle. The secondary outcome was the development of severe (grade 3 or 4) neutropenia (ANC &lt;1000/μL). Regression analyses were used to identify associations between variables and outcomes. Receiver operating characteristic curves were used to calculate threshold dose for each chemotherapy agent potentially associated with the development of severe neutropenia.ResultsA total of 64 eyes of 49 patients (mean [SD] age, 1.7 [1.2] years; 25 females [51.0%]) with retinoblastoma were treated with 171 cycles of IAC. The mean (SD) nadir ANC was 1325.3 (890.7)/μL and occurred a median (IQR) of 10 (10-14) days (range, 6-28 days) after IAC administration. The frequency distribution of post-IAC neutropenia grades 0, 1, 2, 3, 4, and missing was 31 (18.1% of cycles), 25 (14.6%), 40 (23.4%), 37 (21.6%), 26 (15.2%), and 12 (7.0%), respectively. Factors weakly correlated with a lower ANC were higher melphalan dose (β = −2356 [95% CI, –4120.6 to −611.2]; adjusted R2 = 0.251; P = .01) and higher topotecan dose (β = −4056 [95% CI, –7003.6 to −1344.5]; adjusted R2 = 0.251; P = .006).Conclusions and RelevanceIn this case series of patients with retinoblastoma, the incidence of severe neutropenia after IAC was nearly 40%, which is higher than previously reported. Extended laboratory monitoring may aid in capturing previously overlooked cases of neutropenia. Topotecan may be associated with the development of neutropenia; limiting topotecan doses, especially in the setting of a high melphalan dose, may be beneficial in reducing the risk of neutropenia.

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Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever

Richardson

Grewal²,

Visintainer

2009

Cancer

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BACKGROUND:The objective of this study was to determine whether vomiting at presentation of a febrile illness in immunocompromised children with central venous catheters (CVCs) predicts bacteremia.METHODS:A chart review was conducted of children who were admitted to the hospital with a diagnosis of cancer or aplastic anemia, fever, and a CVC. Data were collected on the presence or absence of vomiting, catheter type, presence or absence of severe neutropenia, C‐reactive protein (Crp) value, and culture results.RESULTS:There were 143 admissions for fever among 48 children. Among 35 admissions with emesis, 19 included bacteremia; whereas, among 107 admissions without emesis, 19 included bacteremia (P < .001). There was a 5‐fold greater risk of bacteremia in children with children without vomiting (odds ratio, 5.50; 95% confidence interval, 2.20‐13.67). Gram‐negative organisms were more likely to be associated with vomiting than Gram‐positive organisms (P = .008). Children with severe neutropenia did not have a significantly higher rate of bacteremia than children who had neutrophil counts >500 cells/mm3. Other factors that were associated with higher rates of bacteremia were underlying diagnosis and catheter type.CONCLUSIONS:Immunocompromised children with a CVC and a fever who presented with vomiting were more likely to have bacteremia than similar children who presented without vomiting. Gram‐negative organisms were more likely to be associated with emesis than Gram‐positive organisms. The absence of severe neutropenia was not associated with a decreased likelihood of bacteremia. These findings may be useful in identifying children who are at high risk for bacteremia and in determining initial, empiric therapy. Cancer 2009. © 2009 American Cancer Society.

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A Proposed Score for Predicting Severe Infection Complications in Children With Chemotherapy-induced Febrile Neutropenia

Abstract: This study suggests that patients with FN can be stratified for risk of SIC using clinical parameters at hospital admission.

Cited by 109 publications

References 20 publications

Validasi Sistem Skoring Rondinelli untuk Mendeteksi Komplikasi Infeksi Berat pada Pasien Leukemia Limfoblastik Akut L1 dengan Demam Neutropenia Selama Kemoterapi Fase Induksi

Validasi Sistem Skoring Rondinelli untuk Mendeteksi Komplikasi Infeksi Berat pada Pasien Leukemia Limfoblastik Akut L1 dengan Demam Neutropenia Selama Kemoterapi Fase Induksi

Incidence and Risk Factors for Neutropenia After Intra-Arterial Chemotherapy for Retinoblastoma

Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever

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