The risk factors for febrile neutropenia during chemotherapy in children with malignancy
Keywords:
chemotherapy, febrile neutropenia, malignancy in children
Abstract
Background Febrile neutropenia is the most common side effectof myelosuppressive chemotherapy. It is important to identify its
risk factors to decrease the morbidity and mortality of febrile
neutropenia.
Objective To identify whether age, type of malignancy, phase and
dose of chemotherapy, nutritional status, and absolute neutrophyl
count are risk factors for febrile neutropenia.
Methods A hospital-based case control study was conducted at
Hasan Sadikin Hospital from June 2000 to July 2005. Data was
collected from medical records. The case group consisted of
children with malignancy who received chemotherapy and
suffered from febrile neutropenia, while the control group
consisted of children without febrile neutropenia. Chi square and
logistic regression analysis were performed to analyze data using
SPSS for Windows version 13.0.
Results Eighty-seven cases and 94 controls were evaluated.
Analysis showed that malignancy type i.e, hematologic
malignancy, chemotherapy phase, and absolute neutrophyl count
might be the risk factors for febrile neutropenia (OR=4.6, 95%
CI 1.3;16.7, P=0.019; OR=8.1, 95% CI 2.2;30.5, P=0.002; and
OR=1.0, 95% CI 1.003;1.007, P <0.001, respectively), while age,
chemotherapy dose, and nutritional status might not be the risk
factors (median 60, range 6-144, P=0.342; OR=1.9, 95% CI
0.8;4.8, P=0.129; and P=0.798, respectively).
Conclusion Hematologic malignancy, induction phase of
chemotherapy, and absolute neutrophyl count =250/mm 3 are the
risk factors for febrile neutropenia in children with malignancy
who received chemotherapy.
References
1. Fletcher BD, Pratt CB. Evaluation of the child with a sus-
pected malignant solid tumor. In: Horowitz RE, Pizzo PA,
editors. The pediatric clinics of North America. Philadel-
phia: WB Saunders Co; 1991. p. 223-48.
2. Balis FM, Holcenberg JS, Blaney SM. General principles of
chemotherapy. In: Pizzo PA, Poplack DG, editors. Principles
and practice of pediatric oncology. 3rd ed. Philadelphia:
Lippincott Williams & Willkins; 2002. p. 237-86.
3. Leather HL. Management of chemotherapy - induced
neutropenia. 2004 [cited 2005 Aug 16]. Available from:http:/
/www. pdqce.com/ce/lessons/—— /images/Amgen.Neutropenia.pdf.
4. Berg SL, Poplack DG. Complications of leukemia. Pediatr
Rev 1991;10:313-8.
5. Basu SK, Fernandez ID, Fisher SG. Study of mortality asso-
ciated with febrile neutropenia among children with
cancer. Proc Am Soc Clin Onc 2004;24:801.
6. Sudewi NP, Shabariah R, Tumbeleka AR. Bacteremia in chil-
dren malignancy with febrile neutropenia. [Abstract]
KONIKA XII; 2005.
7. Lucas KG, Brown AE, Armstrong D, Chapma D, Heller G.
The identification of febrile, neutropenic children with
neoplastic disease at low risk for bacteremia and compli-
cations of sepsis. Cancer 1996;77:791-8.
8. Leong DC, Kinlay S, Ackland S. Low-risk febrile neutrope-
nia in a medical oncology unit. Aus New Zealand J Med
1997;27:403-7.
9. Hann I, Viscoli C, Paesmans M. A comparison of outcome
from febrile neutropenic episodes in children compared with
adults: results from four EORTC studies. International
Antimicrobial Therapy Cooperative Group (IATCG) of the
European Organization for Research and Treatment of
Cancer (EORTC). British J Haematol 1997:99:580-8.
10. Alexander SW, Walsh TJ, Freifeld AG, Pizzo PA. Infectious
complications in pediatric cancer patients. In: Pizzo PA,
Poplack DG, editors. Principles and practice of pediatric
oncology. 4th ed. Philadelphia. Lippincott Williams &
Wilkins; 2002. p. 1239-76.
11. Jones GR, Konsler GK, Dunaway RP, Pusek SN. Infection
risk factor in febrile, neutropenic children and adolescents.
Ped Hematol Oncol 1996;13:217-29.
12. Amman RA, Hirt A, Luthy AR, Aebi C. Identification of
children presenting with fever in chemotherapy-induced
neutropenia at low-risk for severe bacterial infection. Med
Ped Oncology 2003;41:436-43.
13. Paganini H, Staffolani U, Zubizarreta P, Casimir L, Lopardo
H, Luppino V. Viridans streptococci bacteraemia in children
with fever and neutropenia: a case-control study of predis-
posing factors. Eur J Can 2004;39:1284-9.
14. Jain V, Dubey AP, Gupta SK. Nutritional parameters in chil-
dren with malignancy. Indian Ped 2003;40:976-84.
15. Kupfer GM. Childhood cancer epidemiology. 2003. cited 2005
Aug 16. Available from: url: http://www.emedicine.com/ped/
topic2585.htm.
16. Shin DD. Neutropenia. cited 2005 Aug 3. Available from:
http://www. emedicine. com/ med/topic1640.htm.
17. Klastersky J, Paesmans M, Rubeinstein EB. The multinational
association for supportive care in cancer risk index: a
multinational scoring system for identifying low-risk fe-
brile neutropenic cancer patients. J Clin Oncol
2000;18:3038-51.
18. Lanzkowsky P. Manual of pediatric hematology and oncol-
ogy. 2nd ed. New York: Churchill Livingstone; 1995.
19. Rivera E, Erder MH, Fridman M, Hortobagy GN. First-cycle
absolute neutrophil count can be used to improve chemo-
therapy-dose delivery and reduce the risk of febrile
neuropenia in patients receiving adjuvant therapy: a valida-
tion study. Breast Cancer 2003;5:R114-20.
20. Orudjev E, Lange BJ. Evolving concepts of management of
febrile neutropenia in children with cancer. Med Ped Oncol
2002;39:77-85.
21. Blay JL, Chauvin F, Le Cesne A. Early lymphopenia after
cytotoxic chemotherapy as a risk factor for febrile neutro-
penia. J Clin Oncol 1996;14:636-43.
22. Geissler K, Koller E, Hubmenn E. Granulocyte colony
stimulating factor as an adjunct to induction chemotherapy
for acute lymphoblastic leukemia. Blood 1997;90:590-6.
23. Pui CH, Boyett JM, Hughes WT. Human granulocyte colony
stimulating factor after induction chemotherapy in children with
acute lymphoblastic leukemia. N Engl J Med 1997;336:1781-7.
pected malignant solid tumor. In: Horowitz RE, Pizzo PA,
editors. The pediatric clinics of North America. Philadel-
phia: WB Saunders Co; 1991. p. 223-48.
2. Balis FM, Holcenberg JS, Blaney SM. General principles of
chemotherapy. In: Pizzo PA, Poplack DG, editors. Principles
and practice of pediatric oncology. 3rd ed. Philadelphia:
Lippincott Williams & Willkins; 2002. p. 237-86.
3. Leather HL. Management of chemotherapy - induced
neutropenia. 2004 [cited 2005 Aug 16]. Available from:http:/
/www. pdqce.com/ce/lessons/—— /images/Amgen.Neutropenia.pdf.
4. Berg SL, Poplack DG. Complications of leukemia. Pediatr
Rev 1991;10:313-8.
5. Basu SK, Fernandez ID, Fisher SG. Study of mortality asso-
ciated with febrile neutropenia among children with
cancer. Proc Am Soc Clin Onc 2004;24:801.
6. Sudewi NP, Shabariah R, Tumbeleka AR. Bacteremia in chil-
dren malignancy with febrile neutropenia. [Abstract]
KONIKA XII; 2005.
7. Lucas KG, Brown AE, Armstrong D, Chapma D, Heller G.
The identification of febrile, neutropenic children with
neoplastic disease at low risk for bacteremia and compli-
cations of sepsis. Cancer 1996;77:791-8.
8. Leong DC, Kinlay S, Ackland S. Low-risk febrile neutrope-
nia in a medical oncology unit. Aus New Zealand J Med
1997;27:403-7.
9. Hann I, Viscoli C, Paesmans M. A comparison of outcome
from febrile neutropenic episodes in children compared with
adults: results from four EORTC studies. International
Antimicrobial Therapy Cooperative Group (IATCG) of the
European Organization for Research and Treatment of
Cancer (EORTC). British J Haematol 1997:99:580-8.
10. Alexander SW, Walsh TJ, Freifeld AG, Pizzo PA. Infectious
complications in pediatric cancer patients. In: Pizzo PA,
Poplack DG, editors. Principles and practice of pediatric
oncology. 4th ed. Philadelphia. Lippincott Williams &
Wilkins; 2002. p. 1239-76.
11. Jones GR, Konsler GK, Dunaway RP, Pusek SN. Infection
risk factor in febrile, neutropenic children and adolescents.
Ped Hematol Oncol 1996;13:217-29.
12. Amman RA, Hirt A, Luthy AR, Aebi C. Identification of
children presenting with fever in chemotherapy-induced
neutropenia at low-risk for severe bacterial infection. Med
Ped Oncology 2003;41:436-43.
13. Paganini H, Staffolani U, Zubizarreta P, Casimir L, Lopardo
H, Luppino V. Viridans streptococci bacteraemia in children
with fever and neutropenia: a case-control study of predis-
posing factors. Eur J Can 2004;39:1284-9.
14. Jain V, Dubey AP, Gupta SK. Nutritional parameters in chil-
dren with malignancy. Indian Ped 2003;40:976-84.
15. Kupfer GM. Childhood cancer epidemiology. 2003. cited 2005
Aug 16. Available from: url: http://www.emedicine.com/ped/
topic2585.htm.
16. Shin DD. Neutropenia. cited 2005 Aug 3. Available from:
http://www. emedicine. com/ med/topic1640.htm.
17. Klastersky J, Paesmans M, Rubeinstein EB. The multinational
association for supportive care in cancer risk index: a
multinational scoring system for identifying low-risk fe-
brile neutropenic cancer patients. J Clin Oncol
2000;18:3038-51.
18. Lanzkowsky P. Manual of pediatric hematology and oncol-
ogy. 2nd ed. New York: Churchill Livingstone; 1995.
19. Rivera E, Erder MH, Fridman M, Hortobagy GN. First-cycle
absolute neutrophil count can be used to improve chemo-
therapy-dose delivery and reduce the risk of febrile
neuropenia in patients receiving adjuvant therapy: a valida-
tion study. Breast Cancer 2003;5:R114-20.
20. Orudjev E, Lange BJ. Evolving concepts of management of
febrile neutropenia in children with cancer. Med Ped Oncol
2002;39:77-85.
21. Blay JL, Chauvin F, Le Cesne A. Early lymphopenia after
cytotoxic chemotherapy as a risk factor for febrile neutro-
penia. J Clin Oncol 1996;14:636-43.
22. Geissler K, Koller E, Hubmenn E. Granulocyte colony
stimulating factor as an adjunct to induction chemotherapy
for acute lymphoblastic leukemia. Blood 1997;90:590-6.
23. Pui CH, Boyett JM, Hughes WT. Human granulocyte colony
stimulating factor after induction chemotherapy in children with
acute lymphoblastic leukemia. N Engl J Med 1997;336:1781-7.
Published
2007-05-01
How to Cite
1.
Sulviani R, Idjradinata P, Raspati H. The risk factors for febrile neutropenia during chemotherapy in children with malignancy. PI [Internet]. 1May2007 [cited 22Nov.2024];47(2):83-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/350
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-05-01
Accepted 2016-08-25
Published 2007-05-01
