Febrile neutropenia (FN) is a common in children receiving chemotherapy and can be life-threatening. Four febrile neutropenia syndromes: primary, prolonged, recurrent and engraftment fever have been described. Recognition of these syndromes may inform the clinical approach to the diagnosis and treatment of FN in pediatric cancer patients.
Retrospective chart review was performed in all pediatric cancer patients with FN from July 2009 to December 2016, Each episode of FN was categorized as 1) Primary, responsive to empiric antibiotic therapy, 2) Prolonged, failing to defervesce after at least 5 days of broad spectrum antibacterial therapy 3) Recurrent, a new episode of fever > 72 hours from resolution of the initial fever episode when the patient remains neutropenic and on antibiotics, or 4) Engraftment fever, a new onset fever or clinical worsening in temporal relationship to neutrophil recovery. Patient demographics and clinical outcomes were compared by syndrome using chi-square and student’s t-test where appropriate to evaluate for differences in presentation, etiologies of fever and clinical outcomes.
562 pediatric FN episodes (FNEs) occurred in 169 patients. 63% of FNEs occurred in patients with hematologic malignancy, 24.4% occurred s/p stem cell transplant (SCT). FNEs were categorized as primary (67.3%), prolonged (18.5%), recurrent (9.6%), and engraftment fever (4.6%). Episodes categorized as prolonged or recurrent occurred most often in patients with hematologic malignancy, 63% and 87%. Bacteremia was documented in 22% of FEs and by syndrome 28.2%, 34%, 26%, and 7.7%, respectively, Fungal infection was documented in 9.4% of FNEs and by syndrome, 2.4%, 19 %, 30%, 30.8%, respectively. When recurrent and prolonged fever episodes were compared, proven fungal infections occurred more often (1% vs 11%) (P value=0.015) and mortality was increased 13% vs 3.8% (P value 0.07) in patients with recurrent fever
Pediatric patients with recurrent febrile neutropenia are more likely to have invasive fungal infections and increased mortality. Prospective studies are needed to inform whether approaches in medical management should differ depending on the presenting febrile neutropenia syndrome.
A. Bartlett, None
L. Petty, None
A. Mayampurath, None
J. Pisano, None