Chemotherapy-induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences

Abstract

Abstract. Chemotherapy-induced neutropenia (CIN) is the major dose-limiting toxicity of systemic chemotherapy and it is associated with significant morbidity, mortality and treatment cost. The aim of the present study was to identify the risk factors that may predispose pediatric cancer patients who receive myelosuppressive chemotherapy to CIN and associated sequelae. A total of 113 neutropenia episodes were analyzed and the risk factors for CIN were classified as patient-specific, disease-specific and regimen-specific, while the consequences of CIN were divided into infectious and dose-modifying sequelae. The risks and consequences were analyzed to target high-risk patients with appropriate preventive strategies. Among our patients, 28% presented with a single neutropenia attack, while 72% experienced recurrent attacks during their treatment cycles. The mean absolute neutrophil count was 225.5±128.5 x10 9 ̸l (range, 10-497 x10 9 ̸l), starting 14.2±16.3 days (range, 2-100 days) after the onset of chemotherapy and resolving within 11.2±7.3 days, either with (45.1%) or without (54.9%) granulocyte colony-stimulating factor (G-CSF). No significant association was observed between any patient characteristics or disease stage and the risk for CIN. However, certain malignancies, such as acute lymphocytic leukemia (ALL), neuroblastoma and Burkitt's lymphoma, and certain regimens, such as induction block for ALL and acute myelocytic leukemia, exerted the most potent myelotoxic effect, with severe and prolonged episodes of neutropenia. G-CSF significantly shortened the duration of the episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complication among our cases (73.5%) and was associated with several documented infections, particularly mucositis (54.9%), respiratory (45.1%), gastrointestinal tract (38.9%) and skin (23.9%) infections. A total of 6% of our patients succumbed to infection-related complications. Neutropenia was responsible for treatment discontinuation (13.3%), dose delay (13.3%) and dose reduction (5.3%) in our patients.

Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients

“…In some studies, it has been reported that FEN attacks develop most commonly in the induction period (36,37). In a study conducted in Turkey, it was reported that febrile neutropenia attacks developed most commonly during the consolidation treatment in patients with pediatric leukemia treated with the BFM protocol (29).…”

A Review on Chemotherapy Induced Complications in Cancer Patients

“…Therapeutic strategies for cancer continue to evolve, and chemotherapy regimens continue to play important roles in cancer treatment 8 .…”

“…These advantages have been documented by other researchers. A recent study on urological cancer patients reported a good outcome when G-CSF was administered 8 .  For alopecia, it was suggested in the study 24, the cooling technique of use of the scalp.…”

Assessment of Hematological Toxicity in Children with Acute Lymphoblastic Leukemia, Receiving Treatment with ALL IC-BFM 2009 Protocol

“…In our trial, as could be seen in Fig.4, the ANC decreases to the lowest values and during induction, severe neutropenia continues. Badr et al [3] suggested that the higher neutropenia incidence during early cycles was due to more intense chemotherapy administered during induction.…”

“…While chemotherapy-associated hematologic toxicity is a well-known topic, there are a few studies evaluating chemotherapy-associated hematologic toxicity [3]- [8].…”