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LÖSEMİ DIŞI ÇOCUKLUK ÇAĞI KANSERLERİNDE FEBRİL NÖTROPENİ ATAKLARININ DEĞERLENDİRİLMESİ

Year 2021, Volume: 4 Issue: 2, 40 - 48, 30.06.2021
https://doi.org/10.53446/actamednicomedia.877259

Abstract

Amaç: Çocukluk çağı solid tümörlerinde febril nötropeni ataklarının klinik seyir ve özelliklerini değerlendirerek uygun bir takip ve tedavi yaklaşımı oluşturmaktır.
Yöntemler: Çalışmamızda, Kasım 2019- Nisan 2020 tarihleri arasında kliniğimizde takip edilen lösemi dışı çocukluk çağı kanseri tanılı 18 yaş altı 30 hastanın 60 febril nötropeni atağı, tedavileri, tedavi yanıtları ve ailelerin sosyo-ekonomik düzeyleri incelendi.
Bulgular: En sık tanılar; nöroblastom (%31,7), Wilms tümörü (%16,7) ve non-Hodgkin lenfoma (%18,3) idi. Ataklar sırasında alınan kültürlerin 15’inde (%25) üreme saptandı. 10 atakta (%16,6) bakteriyemi mevcuttu. Febril atakların %76,7’sinin (46 atak) kemoterapi uygulamasından sonraki ilk 7 gün içinde meydana geldiği saptandı. En fazla atak görülen günler, kemoterapi uygulamasından sonraki 5. ve 6. (%33,4) günlerdi. Başvuru sırasında ateşi daha yüksek olan ve beyaz küre sayısı düşük hastaların ilerleyen süreçte tedavilerinde değişiklik yapılma ihtiyacının diğer hastalara göre daha yüksek olduğu saptandı. Üç hasta (%5) atak sırasında kaybedildi. Aylık geliri 4000 TL üzerinde ve eğitim düzeyi daha düşük olan ailelerin, hastaneye ulaşma sürelerinin anlamlı olarak daha kısa olduğu görüldü.
Sonuç: Febril nötropeni atakları sırasında ailelerin sosyo-kültürel ve ekonomi düzeyleri, iyileşme sürecini doğrudan etkileyebilmektedir.

References

  • 1. Kebudi R, Devecioğlu Ö, Gürler N ve ark. Pediatrik febril nötropeni kılavuzu. Flora 2004;9:73-105
  • 2. Castagnola E, Fontana V, Caviglia I, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis. 2007;45(10):1296-1304. doi:10.1086/522533
  • 3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Infectious Diseases Society of America. Clinical practice guidline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93. doi:10.1093/cid/cir073
  • 4. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34(6):730-751. doi:10.1086/339215
  • 5. Klastersky J, De Naurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO clinical practice guidelines. Ann Oncol. 2016;27(suppl_5):v111-v118. doi:10.1093/annonc/mdw325
  • 6. Kebudi R, Vural S, Anak S, (tüm katılan merkezler adına): Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları raporu. İçinde: Kebudi R, Anak S, Vural S, ed. Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları kitabı. İstanbul Üniversitesi, İstanbul; 2004:95-99
  • 7. Santolaya ME, Alvarez AM, Becker A, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection inchildren with cancer, neutropenia, and fever. J Clin Oncol. 2001;19(14):3415-3421. doi: 10.1200/JCO.2001
  • 8. Rosa RG, Goldani LZ. Factors associated with hospital length of stay among cancer patients with febrile neutropenia: PLoS One. 2014;9(10):e108969. doi: 10.1371/journal.pone.0108969
  • 9. Dayal R, Agarwal D. Fever in Children and Fever of Unknown Origin. Indian J Pediatr. 2016;83(1):38-43. doi:10.1007/s12098-015-1724-4
  • 10. Paul M, Gafter -Givili A, Leibovici L, et al. The epidemiology of bacterimia with febrile notorpenia: experience from a single center, 1988-2004. Isr Med Assoc J. 2007;9(6):424-429.
  • 11. Paul M, Yahav D, Fraser A, Leibovici L. Emprical antibiotic monoterapy for febrile neutropenia: systemic review and metanalysis of randomized controlled trials. J Antimicrob Chemoter. 2006;57(2):176-189. doi:10.1093/jac/dki448
  • 12. Baysallar M, Güçlü AÜ, Şenses Z, Kaplan K, Ataergin S, Başustaoğlu AC. Febril nötropenik hastaların kan kültürlerinde bakteriyal spektrum ve antimikrobial duyarlılık profili. Gülhane Tıp Dergisi. 2007;49: 168-72.
  • 13. Lai Hp, Hsueh PR, Chen YC, et al. Bacteremia in hematological and oncological children with febrile neutropenia: experience in a tertiary medical center in Taiwan. J Microbiol Immunol Infect. 2003;36(3):197-202.
  • 14. Febril Nötropeni Çalışma Grubu. Febril nötropenik hastalarda tanı ve tedavi kılavuzu. Flora Dergisi. 2004;9(1):5-28.
  • 15. De Pauw BE, Donnelly JP. Infections in the immunocompromised host: General principles. In: Mandell GL, Dolin R, Bennett JE, ed. Principles and Practice of Infectious Diseases. 5th Edition. New York: Churchill Livingstone; 2000:3079-3089.
  • 16. Chuang YY, Hung IJ, Yang CP, Jaing TH, Lin TY, Huang YC. Cefepime versus ceftazidime as empiric monotherapy for fever and neutropenia in children with cancer. Pediatr Infect Dis J. 2002;21(3):203-209. doi:10.1097/00006454-200203000-00009
  • 17. Kebudi R, Görgün O, Ayan I, Gürler N, Akici F, Töreci K. Randomized comparison of cefepime versus ceftazidime monotherapy for fever and neutropenia in children with solid tumors. Med Pediatr Oncol. 2001;36(4):434-441. doi:10.1002/mpo.1107
  • 18. Uygun V, Karasu GT, Ogunc D, Yesilipek A, Hazar V. Piperacillin/tazobactam versus cefepime for the empirical treatment of pediatric cancer patients with neutropenia and fever: A randomized and open‐label study. Pediatr Blood Cancer. 2009;53(4):610-614. doi:10.1002/pbc.22100
  • 19. Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother. 2014;58(7):3799-3803. doi:10.1128/AAC.02561-14
  • 20. Daniels LM, Durani U, Barreto JN, et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Supportive Care Cancer. 2019: 27(11):4171-4177. doi: 10.1007/s00520-019-04701-8
  • 21. Gavidia R, Fuentes SL, Vasquez R, et al. Low socioeconomic status is associated with prolonged times to assessment and treatment, sepsis and infectious death in pediatric fever in El Salvador. PLoS One. 2012;7(8):e43639. doi:10.1371/journal.pone.0043639
  • 22. Oberoi S, Trehan A, Marwaha RK, Bansal D. Symptom to door interval in febrile neutropenia: perspective in India. Support Care Cancer. 2013;21(5):1321-1327. doi:10.1007/s00520-012-1668-4
  • 23. Koenig C, Schneider C, Morgan JE, Ammann RA, Sung L, Phillips B. Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review. Supportive Care Cancer. 2020;28(3):1369-1383. doi:10.1007/s00520-019-04961-4
  • 24. Das A, Trehan A, Bansal D. Risk Factors for Microbiologically-documented Infections, Mortality and Prolonged Hospital Stay in Children with Febrile Neutropenia. Indian Pediatr. 2018;55(10):859-864.
  • 25. Mueller EL, Walkovich KJ, Mody R, Gebremariam A, Davis MM. Hospital discharges for fever and neutropeniain pediatric cancer patients: United States, 2009. BMCCancer. 2015;15:388.
  • 26. Agyeman P, Aebi C, Hirt A et al. Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Infect Dis J. 2011;30:e114-e119. doi:10.1097/INF.0b013e318215a290
  • 27. Badiei Z, Khalesi M, Alami MH ve ark. Risk factors associated with lifethreatening infections in children with febrile neutropenia: A data mining approach. J Pediatr Hematol Oncol. 2011;33(1):e9-e12. doi:10.1097/MPH.0b013e3181f6921a

EVALUATION OF FEBRILE NEUTROPENIA ATTACKS IN PATIENTS WITH NON-LEUKEMIA CHILDHOOD CANCER

Year 2021, Volume: 4 Issue: 2, 40 - 48, 30.06.2021
https://doi.org/10.53446/actamednicomedia.877259

Abstract

Objective: To establish an appropriate follow-up and treatment approach by evaluating the clinical course and characteristics of febrile neutropenia attacks in childhood solid tumors.
Methods: In our study; 60 febrile neutropenia attacks, treatments they received, treatment responses and socio-economic levels of families under the age of eighteen years of 30 patients diagnosed with non-leukemia childhood cancer between November 2019 and April 2020 were examined.
Results: The most common diagnoses were neuroblastoma (31.7%), Wilms tumor (16.7%) and non-Hodgkin lymphoma (18.3%). Bacteremia was present in 10 attacks (16.6%). It was found that 76.7% (46 attacks) of febrile attacks occurred within the first 7 days after chemotherapy cure. Most attacks occured on the 5th and 6th days (33.4%). It was found that patients with higher fever temperatures and low white blood cell counts during the hospital admission had a higher need to make changes in their treatment in the future. Three patients (5%) died during febrile neutropenia attacks. It was determined that the families who have monthly income over 4000 TL and lower education level have a significantly shorter reaching time to hospital than other families.
Conclusion: During episodes of febrile neutropenia, the socio-cultural and economic levels of families can directly affect the recovery process.

References

  • 1. Kebudi R, Devecioğlu Ö, Gürler N ve ark. Pediatrik febril nötropeni kılavuzu. Flora 2004;9:73-105
  • 2. Castagnola E, Fontana V, Caviglia I, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis. 2007;45(10):1296-1304. doi:10.1086/522533
  • 3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Infectious Diseases Society of America. Clinical practice guidline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93. doi:10.1093/cid/cir073
  • 4. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34(6):730-751. doi:10.1086/339215
  • 5. Klastersky J, De Naurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO clinical practice guidelines. Ann Oncol. 2016;27(suppl_5):v111-v118. doi:10.1093/annonc/mdw325
  • 6. Kebudi R, Vural S, Anak S, (tüm katılan merkezler adına): Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları raporu. İçinde: Kebudi R, Anak S, Vural S, ed. Pediatrik hematoloji-onkoloji merkezlerinde febril nötropeni tanı ve tedavi uygulamaları, çalışmaları ve sonuçları kitabı. İstanbul Üniversitesi, İstanbul; 2004:95-99
  • 7. Santolaya ME, Alvarez AM, Becker A, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection inchildren with cancer, neutropenia, and fever. J Clin Oncol. 2001;19(14):3415-3421. doi: 10.1200/JCO.2001
  • 8. Rosa RG, Goldani LZ. Factors associated with hospital length of stay among cancer patients with febrile neutropenia: PLoS One. 2014;9(10):e108969. doi: 10.1371/journal.pone.0108969
  • 9. Dayal R, Agarwal D. Fever in Children and Fever of Unknown Origin. Indian J Pediatr. 2016;83(1):38-43. doi:10.1007/s12098-015-1724-4
  • 10. Paul M, Gafter -Givili A, Leibovici L, et al. The epidemiology of bacterimia with febrile notorpenia: experience from a single center, 1988-2004. Isr Med Assoc J. 2007;9(6):424-429.
  • 11. Paul M, Yahav D, Fraser A, Leibovici L. Emprical antibiotic monoterapy for febrile neutropenia: systemic review and metanalysis of randomized controlled trials. J Antimicrob Chemoter. 2006;57(2):176-189. doi:10.1093/jac/dki448
  • 12. Baysallar M, Güçlü AÜ, Şenses Z, Kaplan K, Ataergin S, Başustaoğlu AC. Febril nötropenik hastaların kan kültürlerinde bakteriyal spektrum ve antimikrobial duyarlılık profili. Gülhane Tıp Dergisi. 2007;49: 168-72.
  • 13. Lai Hp, Hsueh PR, Chen YC, et al. Bacteremia in hematological and oncological children with febrile neutropenia: experience in a tertiary medical center in Taiwan. J Microbiol Immunol Infect. 2003;36(3):197-202.
  • 14. Febril Nötropeni Çalışma Grubu. Febril nötropenik hastalarda tanı ve tedavi kılavuzu. Flora Dergisi. 2004;9(1):5-28.
  • 15. De Pauw BE, Donnelly JP. Infections in the immunocompromised host: General principles. In: Mandell GL, Dolin R, Bennett JE, ed. Principles and Practice of Infectious Diseases. 5th Edition. New York: Churchill Livingstone; 2000:3079-3089.
  • 16. Chuang YY, Hung IJ, Yang CP, Jaing TH, Lin TY, Huang YC. Cefepime versus ceftazidime as empiric monotherapy for fever and neutropenia in children with cancer. Pediatr Infect Dis J. 2002;21(3):203-209. doi:10.1097/00006454-200203000-00009
  • 17. Kebudi R, Görgün O, Ayan I, Gürler N, Akici F, Töreci K. Randomized comparison of cefepime versus ceftazidime monotherapy for fever and neutropenia in children with solid tumors. Med Pediatr Oncol. 2001;36(4):434-441. doi:10.1002/mpo.1107
  • 18. Uygun V, Karasu GT, Ogunc D, Yesilipek A, Hazar V. Piperacillin/tazobactam versus cefepime for the empirical treatment of pediatric cancer patients with neutropenia and fever: A randomized and open‐label study. Pediatr Blood Cancer. 2009;53(4):610-614. doi:10.1002/pbc.22100
  • 19. Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother. 2014;58(7):3799-3803. doi:10.1128/AAC.02561-14
  • 20. Daniels LM, Durani U, Barreto JN, et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Supportive Care Cancer. 2019: 27(11):4171-4177. doi: 10.1007/s00520-019-04701-8
  • 21. Gavidia R, Fuentes SL, Vasquez R, et al. Low socioeconomic status is associated with prolonged times to assessment and treatment, sepsis and infectious death in pediatric fever in El Salvador. PLoS One. 2012;7(8):e43639. doi:10.1371/journal.pone.0043639
  • 22. Oberoi S, Trehan A, Marwaha RK, Bansal D. Symptom to door interval in febrile neutropenia: perspective in India. Support Care Cancer. 2013;21(5):1321-1327. doi:10.1007/s00520-012-1668-4
  • 23. Koenig C, Schneider C, Morgan JE, Ammann RA, Sung L, Phillips B. Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review. Supportive Care Cancer. 2020;28(3):1369-1383. doi:10.1007/s00520-019-04961-4
  • 24. Das A, Trehan A, Bansal D. Risk Factors for Microbiologically-documented Infections, Mortality and Prolonged Hospital Stay in Children with Febrile Neutropenia. Indian Pediatr. 2018;55(10):859-864.
  • 25. Mueller EL, Walkovich KJ, Mody R, Gebremariam A, Davis MM. Hospital discharges for fever and neutropeniain pediatric cancer patients: United States, 2009. BMCCancer. 2015;15:388.
  • 26. Agyeman P, Aebi C, Hirt A et al. Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Infect Dis J. 2011;30:e114-e119. doi:10.1097/INF.0b013e318215a290
  • 27. Badiei Z, Khalesi M, Alami MH ve ark. Risk factors associated with lifethreatening infections in children with febrile neutropenia: A data mining approach. J Pediatr Hematol Oncol. 2011;33(1):e9-e12. doi:10.1097/MPH.0b013e3181f6921a
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Paediatrics, Oncology and Carcinogenesis
Journal Section Research Articles
Authors

Kübra Uçak 0000-0001-9810-8930

Mehmet Azizoğlu 0000-0002-9982-8005

Uğur Demirsoy 0000-0002-5424-7215

Funda Çorapçıoğlu

Publication Date June 30, 2021
Submission Date February 9, 2021
Acceptance Date April 29, 2021
Published in Issue Year 2021 Volume: 4 Issue: 2

Cite

AMA Uçak K, Azizoğlu M, Demirsoy U, Çorapçıoğlu F. LÖSEMİ DIŞI ÇOCUKLUK ÇAĞI KANSERLERİNDE FEBRİL NÖTROPENİ ATAKLARININ DEĞERLENDİRİLMESİ. Acta Med Nicomedia. June 2021;4(2):40-48. doi:10.53446/actamednicomedia.877259

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