Febrile neutropenia in childhood leukemia: Manado experience 1997 - 2006
Keywords:
leukemia, febrile neutropenia, antibiotic, outcome
Abstract
Background Febrile neutropenia (FNP) is a common complicationof therapy among children with cancer. It is one of the causes of
significant morbidity and mortality in children and young adults
treated for cancer. With aggressive management of FNP, the
outcome of episodes in children has improved dramatically.
Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years.
Methods Data from medical records was collected retrospectively
from January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients.
Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied.
Conclusion The outcome of FNP in our institution is grave.
There is a need to evaluate application and compliance to the
standard guidelines.
References
1. Orudjev E, Lange BJ. Evolving concepts of management
of febrile neutropenia in children with cancer. Med Pediatr
Oncol. 2002;39(2):77-85.
2. Hann I, Viscoli C, Paesmans M, Gaya H, Glauser MA. 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). Br J Haematol.
1997;99(3):580-8.
3. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE,
Calandra T, et al. 2002 guidelines for the use of antimicrobial
agents in neutropenic patients with cancer. Clin Infect Dis.
2002;34:730-51.
4. Ozer H, Armitage JO, Bennett CL, Crawford J Demetri GD,
Pizzo PA, eta!. 2000 update of recommendations for the use
of hematopoietic colony-stimulating factors: evidence-based,
clinical practice guidelines-American Society of Clinical
Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;
18:3558-85.
5. Phillips B, Selwood K, Lane SM, Skinner R, Gibson F,
Chisholm ]C. Variation in policies for the management of
febrile neutropenia in United Kingdom children's cancer
study group centres. Arch Dis Child. 2007;92:495-8.
6. Mostert S, Gundy GM, Sutaryo, Sitaresmi MN, Veerman
A]. Influence of socioeconomic status on childhood acute
lymphoblastic leukemia treatment in Indonesia. Pediatrics.
2006; 118:e1600-e1606.
7. Sudewi NP, Windiastuti E, Tumbelaka AR. Kejadian demam
neutropenia pad a keganasan. Sari Pediatri. 2007 ;8 (3) :68-72.
8. Sulviani R, Idjradinata P, Raspati H. The risk factors for
febrile neutropenia during chemotherapy in children with
malignancy. Paediatr Indones. 2007;47(2):83-7.
9. Jain V, Dubey AP, Gupta SK. Nutritional parameters in
children with malignancy. Indian Pediatr. 2003;40:976-84.
10. Basu SK, Fernandez ID, Fisher SG, Asselin BL, LymanGH.
Length of stay and mortality associated with febrile
neutropenia among children with cancer. J Clin On col. 2005;
23:7958-66.
11. Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood
acute lymphoblastic leukemia: an analysis of 222 febrile
neutropenic episodes. Pediatr Hematol Oncol. 2008;
25 (5) :385-92.
12. Neth 0, Hann I, Turner MW, Klein NJ. Deficiency
of mannose-binding lectin and burden of infection in
children with malignancy: a prospective study. Lancet.
2001;358:614-8.
13. Frakking FNJ, van de Wetering MD, Brouwer N, Dolman
KM, Geissier J, Lemkes B, eta!. The role of mannose binding
lectin (MBL) in paediatric oncology patients with febrile
neutropenia. Eur J Cancer. 2006; 12:909-16.
14. Ammann 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
Pediatr On col. 2003 ;41 :4 36-4 3.
15. Paganini HR, Aguirre C, Puppa G, Garbini C, Javier RG,
Ensinck G, eta!. A prospective, multicentric scoring system
to predict mortality in febrile neutropenia children with
cancer. Cancer. 2007;109(12):2572-9.
16. Boragina M, Patel H, Reiter S, Dougherty G. Management
of febrile neutropenia in Pediatric Oncology patients : a
Canadian survey. Pediatr Blood Cancer. 2007;48(5):521-6.
17. Santaloya ME, Alvarez AM, Aviles CL, Becker A, King
A, Mosso C, et al. Predictors of severe sepsis not clinically
apparent during the first twenty-four hours of hospitalization
in children with cancer, neutropenia, and fever: a prospective,
multicenter trial. Pediatr Infect Dis J. 2008;27 (6) :538-43.
18. El-Maghraby SM, Moneer MM, Ismail MM, Shalaby LM, El-Mahallawy
HA. The diagnostic value of C-reactive protein,
interleukin-8, and monocyte chemotactic protein in risk
stratification of febrile neutropenic children with hematologic
malignancies. J Pediatr Hematol Oncol. 2007;29(3):131-6.
19. Prat C, Sancho JM, Dominguez J , Xicoy B, Gimenez M, Ferra
C, et a!. Evaluation of procalcitonin, neopterin, C-reactive
protein, IL-6 and IL-8 as a diagnostic marker of infection
in patients with febrile neutropenia. Leuk Lymphoma.
2008;49(9): 1752-61.
20. Laoprasopwattana K, Pruekprasert P, Laosombat V,
Wongchanchailert M. Clinical outcome of febrile neutropenia
in children with cancer using ceftazidime and aminoglycosides.
Pediatr Hematol On col. 2007 ;24(8) :595-606.
21. Corap~ioglu F, Sarper N. Cefepime versus ceftazidime +
amikacin as empirical therapy for febrile neutropenia in
children with cancer: a prospective randomized trial of
the treatment efficacy and cost. Pediatr Hematol Oncol.
2005;22(1):59-70.
22. Yildrim I, Aytac S, Ceyhan M, Cetin M, Tuncer M, Cengiz
AB, et a!. Piperacillin/tazobactam plus amikacin versus
carbapenem monotherapy as empirical treatment of febrile
neutropenia in childhood hematological malignancies.
Pediatr Hematol Oncol. 2008;25 (4):291-9.
23. Sato T, Kobayashi R, Yasuda K, Kaneda M, Iguchi A,
KobayashiK. A prospective, randomized study comparing
cefozopran with piperacillin-tazobactam plus ceftazidime
as empirical therapy for febrile neutropenia in children
with hematological disorders. Pediatr Blood Cancer.
2008;51(6); 774-7.
24. Park JR, Coughlin J, Hawkins D, Friedman DL, Burns JL,
Pendergrass T. Ciprofloxacin and amoxicillin as continuation
treatment of febrile neutropenia in pediatric cancer patients.
Med Pediatr Oncol. 2003;40(2):93-8.
of febrile neutropenia in children with cancer. Med Pediatr
Oncol. 2002;39(2):77-85.
2. Hann I, Viscoli C, Paesmans M, Gaya H, Glauser MA. 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). Br J Haematol.
1997;99(3):580-8.
3. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE,
Calandra T, et al. 2002 guidelines for the use of antimicrobial
agents in neutropenic patients with cancer. Clin Infect Dis.
2002;34:730-51.
4. Ozer H, Armitage JO, Bennett CL, Crawford J Demetri GD,
Pizzo PA, eta!. 2000 update of recommendations for the use
of hematopoietic colony-stimulating factors: evidence-based,
clinical practice guidelines-American Society of Clinical
Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;
18:3558-85.
5. Phillips B, Selwood K, Lane SM, Skinner R, Gibson F,
Chisholm ]C. Variation in policies for the management of
febrile neutropenia in United Kingdom children's cancer
study group centres. Arch Dis Child. 2007;92:495-8.
6. Mostert S, Gundy GM, Sutaryo, Sitaresmi MN, Veerman
A]. Influence of socioeconomic status on childhood acute
lymphoblastic leukemia treatment in Indonesia. Pediatrics.
2006; 118:e1600-e1606.
7. Sudewi NP, Windiastuti E, Tumbelaka AR. Kejadian demam
neutropenia pad a keganasan. Sari Pediatri. 2007 ;8 (3) :68-72.
8. Sulviani R, Idjradinata P, Raspati H. The risk factors for
febrile neutropenia during chemotherapy in children with
malignancy. Paediatr Indones. 2007;47(2):83-7.
9. Jain V, Dubey AP, Gupta SK. Nutritional parameters in
children with malignancy. Indian Pediatr. 2003;40:976-84.
10. Basu SK, Fernandez ID, Fisher SG, Asselin BL, LymanGH.
Length of stay and mortality associated with febrile
neutropenia among children with cancer. J Clin On col. 2005;
23:7958-66.
11. Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood
acute lymphoblastic leukemia: an analysis of 222 febrile
neutropenic episodes. Pediatr Hematol Oncol. 2008;
25 (5) :385-92.
12. Neth 0, Hann I, Turner MW, Klein NJ. Deficiency
of mannose-binding lectin and burden of infection in
children with malignancy: a prospective study. Lancet.
2001;358:614-8.
13. Frakking FNJ, van de Wetering MD, Brouwer N, Dolman
KM, Geissier J, Lemkes B, eta!. The role of mannose binding
lectin (MBL) in paediatric oncology patients with febrile
neutropenia. Eur J Cancer. 2006; 12:909-16.
14. Ammann 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
Pediatr On col. 2003 ;41 :4 36-4 3.
15. Paganini HR, Aguirre C, Puppa G, Garbini C, Javier RG,
Ensinck G, eta!. A prospective, multicentric scoring system
to predict mortality in febrile neutropenia children with
cancer. Cancer. 2007;109(12):2572-9.
16. Boragina M, Patel H, Reiter S, Dougherty G. Management
of febrile neutropenia in Pediatric Oncology patients : a
Canadian survey. Pediatr Blood Cancer. 2007;48(5):521-6.
17. Santaloya ME, Alvarez AM, Aviles CL, Becker A, King
A, Mosso C, et al. Predictors of severe sepsis not clinically
apparent during the first twenty-four hours of hospitalization
in children with cancer, neutropenia, and fever: a prospective,
multicenter trial. Pediatr Infect Dis J. 2008;27 (6) :538-43.
18. El-Maghraby SM, Moneer MM, Ismail MM, Shalaby LM, El-Mahallawy
HA. The diagnostic value of C-reactive protein,
interleukin-8, and monocyte chemotactic protein in risk
stratification of febrile neutropenic children with hematologic
malignancies. J Pediatr Hematol Oncol. 2007;29(3):131-6.
19. Prat C, Sancho JM, Dominguez J , Xicoy B, Gimenez M, Ferra
C, et a!. Evaluation of procalcitonin, neopterin, C-reactive
protein, IL-6 and IL-8 as a diagnostic marker of infection
in patients with febrile neutropenia. Leuk Lymphoma.
2008;49(9): 1752-61.
20. Laoprasopwattana K, Pruekprasert P, Laosombat V,
Wongchanchailert M. Clinical outcome of febrile neutropenia
in children with cancer using ceftazidime and aminoglycosides.
Pediatr Hematol On col. 2007 ;24(8) :595-606.
21. Corap~ioglu F, Sarper N. Cefepime versus ceftazidime +
amikacin as empirical therapy for febrile neutropenia in
children with cancer: a prospective randomized trial of
the treatment efficacy and cost. Pediatr Hematol Oncol.
2005;22(1):59-70.
22. Yildrim I, Aytac S, Ceyhan M, Cetin M, Tuncer M, Cengiz
AB, et a!. Piperacillin/tazobactam plus amikacin versus
carbapenem monotherapy as empirical treatment of febrile
neutropenia in childhood hematological malignancies.
Pediatr Hematol Oncol. 2008;25 (4):291-9.
23. Sato T, Kobayashi R, Yasuda K, Kaneda M, Iguchi A,
KobayashiK. A prospective, randomized study comparing
cefozopran with piperacillin-tazobactam plus ceftazidime
as empirical therapy for febrile neutropenia in children
with hematological disorders. Pediatr Blood Cancer.
2008;51(6); 774-7.
24. Park JR, Coughlin J, Hawkins D, Friedman DL, Burns JL,
Pendergrass T. Ciprofloxacin and amoxicillin as continuation
treatment of febrile neutropenia in pediatric cancer patients.
Med Pediatr Oncol. 2003;40(2):93-8.
Published
2009-12-31
How to Cite
1.
Gunawan S, Rampengan N, Mantik M, Rampengan T. Febrile neutropenia in childhood leukemia: Manado experience 1997 - 2006. PI [Internet]. 31Dec.2009 [cited 25Apr.2024];49(6):372-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/604
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Received 2016-09-12
Accepted 2016-09-12
Published 2009-12-31
Accepted 2016-09-12
Published 2009-12-31
