Fever and neutropenia in children with solid tumors is similar in severity and outcome to that in children with leukemia

Abstract

There is growing interest in developing criteria that will allow efficient prospective discrimination between cancer patients at high and at low risk for complex fever and neutropenia. The objective of this study was to determine whether there were differences in patterns of documented infections and outcome of episodes of fever and neutropenia in pediatric patients with leukemia and those with solid tumors, a potential risk factor. A total of 283 febrile neutropenia episodes in pediatric cancer patients at a single center were retrospectively reviewed; 38% of the patients concerned had leukemia and 62% had solid tumors. Fever of unexplained origin was seen in 73% and 74% of episodes in patients with leukemia and solid tumor, respectively. Bacteremia occurred in 18% and 16% of patients in these respective groups. There was no difference in the type of microorganisms that were isolated in the groups, with gram positives predominating in both. The median duration of fever was 2 days in both groups. The depth of neutropenia was similar, with 75% of leukemia patients and 70% of solid tumor patients presenting with ANC of 100 cells/microl or lower. The median duration of neutropenia was 9 days in patients with leukemia and 6 days in solid tumor patients. The median duration of antibiotic treatment was 9 days and 7.5 days in the same respective groups. Antibiotic modification occurred in 25% episodes of febrile neutropenia in leukemia patients and in 11% of episodes in solid tumor patients. No deaths occurred in either group. Subgroup analysis of leukemic patients suggested that patients in the induction phase of therapy have a higher rate of bacteremia and pneumonia. No substantial difference in course or outcome was seen between the leukemia and solid tumor groups, possibly because of the intensive treatment administered to pediatric patients with solid tumors. Risk assessment strategies based on chemotherapy dose intensity and patient comorbidities rather than underlying malignancy should be prospectively studied.

Low prevalence of complications in severe neutropenic children with cancer in the unprotected environment of an overnight camp

“…Overall, nine patients (26%) were hospitalized for management of fever and neutropenia within the study period. This rate is comparable to the reported rate in the literature with respect to aggressive ALL and solid tumor protocols 13–16, suggesting that there is no increased risk to patients in this setting. Only one patient (3%) had definitive evidence of microbial infection.…”

Imipenem-cilastatin versus piperacillin-tazobactam as monotherapy in febrile neutropenia

“…Leukemia is not generally included in low‐risk groups because bone marrow suppression is more severe and of longer duration 28–31 . However, some studies have reported that the course of febrile neutropenia did not differ in leukemia and solid tumors 32 . Fanci et al.…”

“…[28][29][30][31] However, some studies have reported that the course of febrile neutropenia did not differ in leukemia and solid tumors. 32 Fanci et al suggested that piperacillin-tazobactam might be a reasonable option in patients with acute leukemia. 33 Recently, satisfying results with monotherapy in high-risk groups were also informed.…”

Risk Factors for Febrile Neutropenia in Children With Solid Tumors Treated With Cisplatin-based Chemotherapy

“…[5][6][7][8][9][10] Children with hematologic malignancies have been considered at increased risk of FN, although other studies show that solid tumors have the same pattern of FN severity and outcomes. 11 Moreover, it has also been reported that malnutrition, number of previous chemotherapy regimens of >3, and combination chemotherapy with >3 drugs were associated with FN onset in children and adults with bone and soft-tissue sarcoma. 12 In our clinical setting, a large number of pediatric patients receiving CDDPBC develop FN and creates a health problem.…”