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Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience
Nihal Özdemir1, Gülen Tüysüz1, Nigar Çelik2
1Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
Insights
Febrile neutropenia attacks in children with acute lymphoblastic leukemia have increased over time, particularly during relapse treatment. Early evaluation by hematology-oncology units is crucial for successful management of these serious chemotherapy complications.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Diseases
Background:
- Febrile neutropenia is a critical complication of chemotherapy in pediatric leukemia.
- Intensive treatment regimens aim to improve survival but can increase the risk of febrile neutropenia.
Purpose of the Study:
- To assess the clinical features and outcomes of febrile neutropenia in children treated for acute lymphoblastic leukemia.
- To identify trends and risk factors associated with febrile neutropenia during treatment.
Main Methods:
- Retrospective analysis of 96 children with acute lymphoblastic leukemia treated between 1995 and 2010.
- Evaluation of demographic data, treatment details, febrile neutropenia incidence, and microbiological cultures.
Main Results:
- A total of 299 febrile neutropenia episodes were analyzed.
- Incidence of febrile neutropenia increased significantly after the year 2000 and was higher during relapse treatment.
- Bacterial infections were predominant (86%), with Coagulase-negative staphylococcus and E. coli as common pathogens.
Conclusions:
- The incidence of febrile neutropenia has risen, correlating with increased treatment intensity.
- While higher treatment intensity improves survival, it necessitates vigilant monitoring for febrile neutropenia.
- Regular evaluation of febrile neutropenia data by hematology-oncology teams is vital for timely and effective treatment.
Aim:
An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia.
Material And Methods:
Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients' files.
Results:
A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen.
Conclusions:
In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving survival. Evaluation of febrile neutropenia results by hematology-oncology units in years will be directive in early and successful treatment.
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