Evolving concepts of management of febrile neutropenia in children with cancer

Orudjev, Elmar; Lange, Beverly J.

doi:10.1002/mpo.10073

Cited by 65 publications

(51 citation statements)

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“…2,7 The reported mortality rate for patients with FN is <5%. 4,5,7 This low incidence is similar to the results from our current study and makes it necessary to gather a large numbers of patients to obtain valid conclusions. Other studies have analyzed variables related to FN in low-risk patients to test ambulatory and oral therapies.…”

Section: Discussionsupporting

confidence: 86%

“…8,9,[13][14][15][16][17] Several factors predict the onset of severe bacterial infections, bacteremia, or infection-related mortality, such as underlying disease characteristics (bone marrow involvement, recurrence, second tumor, highly myelotoxic chemotherapy, genetic diseases, delayed bone marrow recovery), severe neutropenia, predicted neutropenia for >7 days, absolute monocyte count <100/mm 3 , fever >398C, thrombocytopenia <50.000/mm 3 , fever onset <7 days after the last chemotherapy course, signs of sepsis, arterial hypotension, and associated comorbid factors. [3][4][5][6][7][8][9][10]22,25,26 A score to predict mortality is a useful tool to evaluate and manage patients with severe infections. A major advantage is the objectivity of criteria to evaluate patients.…”

Section: Discussionmentioning

confidence: 99%

“…3 Several additional approaches have been attempted during the last decade, and many studies succeeded in identifying a subset of patients with lower risk of developing infectious complications and death. 4 Bacteremia, other severe bacterial infections, and mortality were the most frequently assessed variable. [5][6][7][8][9] However, the studies that intended to identify risk factors used different designs and definitions, hindering the development of a standardized risk profile.…”

Section: Methods Between March 2000 and July 2004mentioning

confidence: 99%

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A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer

Paganini

Aguirre

Puppa

et al. 2007

Cancer

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BACKGROUND.Many studies have succeeded in identifying a subset of children with febrile neutropenia (FN) who are at lower risk of infectious complications and eventual death. Conversely, to the authors' knowledge, no scoring system has been published to date with which to assess the risk of mortality for the whole group of children with neutropenia and fever.METHODS.Between March 2000 and July 2004, 1520 episodes of FN in 981 children were included in a multicentric prospective study to evaluate a scoring system that was designed to identify high mortality risk at the onset of an FN episode in children with cancer.RESULTS.In the derivation set (714 episodes), 18 patients died (2.5%). A multivariate analysis yielded the following significant mortality‐related risk factors: advanced stage of underlying malignant disease (odds ratio [OR], 3122.1; 95% confidence interval [95% CI], 0.0001–5.2), associated comorbidity (OR, 25.3; 95% CI, 7.7–83.2), and bacteremia (OR, 7.2; 95% CI, 2.4–22.0). A mortality score could be built with 3 points scored for the presence of advanced‐stage underlying malignant disease, 2 points scored for the presence of associated comorbidity, and 1 point scored for bacteremia. If patients collected 4 points of the risk score at onset, then their risk of mortality was 5.8%; if patients had a score of 5 points, then their risk of mortality was 15.4%; and, if they reached the maximum score of 6 points, then their risk of mortality was raised to 40%. The sensitivity of the scoring system was 100%, and it had a specificity of 84.2%. In the validation set (806 episodes), 19 children died (2.3%). For children with scores >3, the scoring system had a sensitivity of 84.2%, a specificity of 83.2%, and a negative predictive value of 99.54% for predicting mortality.CONCLUSIONS.The use of a mortality score for high‐risk patients was validated statistically by the current results. This is a major prognostic approach to categorize patients with high‐risk FN at onset. A better initial predictive approach may allow better therapeutic decisions for these children, with an eventual impact on reducing mortality. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Methods Between March 2000 and July 2004mentioning

confidence: 99%

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A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer

Paganini

Aguirre

Puppa

et al. 2007

Cancer

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“…Birçok çal›flmada onkolojik hastal›¤›n remisyonda olmamas› da risk etmeni olarak say›lmaktad›r. Yüksek doz ARA-C içeren kemoterapi rejimleri özellikle S.viridans ve mantar enfeksiyonlar› aç›s›ndan yüksek enfeksiyöz ölüm oran› ile iliflkili bulunmufltur (21,22).…”

Section: Atefl Süresiunclassified

Lenfoma ve solid tümörlü çocuklarda febril nötropeni: Tek merkez deneyimi

Demirkaya¹,

Özgür²,

Çelebi³

et al. 2010

tpa

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L Le en nf fo om ma a v ve e s so ol li id d t tü üm mö ör rl lü ü ç ço oc cu uk kl la ar rd da a f fe eb br ri il l n nö öt tr ro op pe en ni i: : T Te ek k m me er rk ke ez z d de en ne ey yi im mi i F Fe eb br ri il le e n ne eu ut tr ro op pe en ni ia a i in n c ch hi il ld dr re en n w wi it th h l ly ym mp ph ho om ma a a an nd d s so ol li id d t tu um mo or rs s: : O On ne e c ce en nt te er r e ex xp pe er ri ie en nc ce e M Me et ti in n D De em mi ir rk ka ay ya a* *, , T Ta an ne er r Ö Öz zg gü ür r, , S So ol lm ma az z Ç Çe el le eb bi i* ** *, , B Be et tü ül l S Se ev vi in ni ir r* *, , M Mu us st ta af fa a H Ha ac c› ›m mu us st ta af fa ao o¤ ¤l lu u* ** * Results:The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296±342/mm 3 , 518±896/mm 3 , 144±262/mm 3 , respectively. The mean C-reactive protein (CRP) level was 7.63±7.06 mg/dL, Hb level was 8.67±1.74 g/dL and fever was 38.5±0.2°C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions:The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination. (Turk Arch Ped 2010; 45: 353-8)

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“…1,13 Akhir-akhir ini diketahui bahwa tidak semua pasien dengan demam neutropenia mempunyai risiko yang sama untuk terjadinya morbiditas dan mortalitas yang bermakna akibat infeksi yang berat. 16 Antara 33%-50% pasien mempunyai risiko rendah untuk terjadinya komplikasi infeksi berat, sehingga pada pasien ini memungkinkan untuk dapat berobat jalan dengan pemberian antibiotik oral.…”

Section: Hasilunclassified

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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Evolving concepts of management of febrile neutropenia in children with cancer

Cited by 65 publications

References 50 publications

A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer

A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer

Lenfoma ve solid tümörlü çocuklarda febril nötropeni: Tek merkez deneyimi

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

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