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Neutropenia and Infection Prophylaxis in Childhood Cancer
Stephanie Villeneuve1, Catherine Aftandilian2
1Paediatric Haemotology/Oncology, Dalhousie University and the IWK Health Centre, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
Insights
Pediatric oncology patients at high risk for infection benefit from bacterial and fungal prophylaxis, especially those with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. Evidence for ancillary interventions remains limited.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Pediatric oncology patients often experience neutropenia, increasing infection risk, morbidity, and mortality.
- Hematologic malignancies pose the highest infection risk in this population.
Purpose of the Study:
- To review current data on infection prophylaxis in pediatric oncology patients.
- To focus on pharmacologic and ancillary interventions, excluding hematopoietic stem cell transplantation recipients.
Main Methods:
- Literature review of studies on infection prophylaxis in pediatric oncology.
- Analysis of data on bacterial, fungal, and ancillary interventions.
Main Results:
- Bacterial and fungal prophylaxis are effective in specific high-risk groups.
- Ancillary measures like G-CSF, IVIG, and chlorhexidine baths lack sufficient data for routine use.
- Limited data exists for immunotherapy and solid tumor patients; further research is needed.
Conclusions:
- Bacterial and fungal prophylaxis should be considered for acute myeloid leukemia and relapsed acute lymphoblastic leukemia.
- Additional supportive care may benefit patients with Down syndrome and adolescent/young adult patients.
- More research is required for immunotherapy and other supportive measures.
Purpose Of Review:
Pediatric oncology patients frequently experience episodes of prolonged neutropenia which puts them at high risk for infection with significant morbidity and mortality. Here, we review the data on infection prophylaxis with a focus on both pharmacologic and ancillary interventions. This review does not include patients receiving hematopoietic stem cell transplantation.
Recent Findings:
Patients with hematologic malignancies are at highest risk for infection. Bacterial and fungal prophylaxis decrease the risk of infection in certain high-risk groups. Ancillary measures such as ethanol locks, chlorhexidine gluconate baths, GCSF, IVIG, and mandatory hospitalization do not have enough data to support routine use. There is limited data on risk of infection and role of prophylaxis in patients receiving immunotherapy and patients with solid tumors. Patients with Down syndrome and adolescent and young adult patients may benefit from additional supportive care measures and protocol modifications. Consider utilizing bacterial and fungal prophylaxis in patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. More research is needed to evaluate other supportive care measures and the role of prophylaxis in patients receiving immunotherapy.
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