pediatrics
Contributions
Type: Publication Only
Background
Chemotherapy –induced neutropenia (CIN) is the major dose-limiting toxicity of systemic chemotherapy, and is associated with substantial morbidity, mortality and costs.
Aims
The aim of the current work was to identify risk factors that may predispose pediatric cancer patients, treated with myelo-suppressive chemotherapy, to CIN and associated sequels.
Methods
113 neutropenia episodes were analyzed, risk factors for CIN were classified into; patient-specific, disease-specific and regimen specific while consequences associated with CIN were divided into infectious and dose modifying sequels. Both risks and consequences were analyzed to target high risk patients with appropriate preventive strategies.
Results
28% of our patients presented with single neutropenia attack while 72% of them experienced recurrent attacks during their treatment cycles. Mean absolute neutrophil count (ANC) was 225.5±128.5 (109/L), ranged from 10-497(109/L) started at 14.2±16.3 days (ranged 2-100) after the onset of chemotherapy and resolved within 11.2±7.3 days either with (45.1%) or without (54.9%) granulocyte colony stimulating factor (G-CSF).No significant association could be found between any patient character or disease stage and the risk for CIN. However, certain malignancies (ALL, Neuroblastoma and Burkitt's lymphoma) and certain regimens (induction blocks for ALL, AML) had the worst myelotoxic effect with severe and prolonged neutropenia episodes. G-CSF significantly shortened the neutropenia episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complications among our cases (73.5%), associated with several documented infections particularly mucositis (54.9%), respiratory (45.1%), GIT (38.9%) and skin (23.9%) infections. 6% of our cases died of infection –related complications. Neutropenia was responsible for treatment discontinue (13.3%), dose delay (13.3%), and dose reduction (5.3%) of our patients. The mean cost for each episode in our service was 9386.5±6688.9 Egyptian pounds (L.E) which represented a significant burden on health care providers.
Summary
Although this study is preliminary survey with relatively small number of patients, our findings are relevant to clinical care of pediatric cancer patients in our region. Special attention to CIN prevention should be directed to hematologic malignancy cases especially at early cycles. Severe and prolonged neutropenia are life-threatening events that need aggressive management.
Keyword(s): Cancer, Chemotherapy, Neutropenia, Risk factor
Session topic: Publication Only
Type: Publication Only
Background
Chemotherapy –induced neutropenia (CIN) is the major dose-limiting toxicity of systemic chemotherapy, and is associated with substantial morbidity, mortality and costs.
Aims
The aim of the current work was to identify risk factors that may predispose pediatric cancer patients, treated with myelo-suppressive chemotherapy, to CIN and associated sequels.
Methods
113 neutropenia episodes were analyzed, risk factors for CIN were classified into; patient-specific, disease-specific and regimen specific while consequences associated with CIN were divided into infectious and dose modifying sequels. Both risks and consequences were analyzed to target high risk patients with appropriate preventive strategies.
Results
28% of our patients presented with single neutropenia attack while 72% of them experienced recurrent attacks during their treatment cycles. Mean absolute neutrophil count (ANC) was 225.5±128.5 (109/L), ranged from 10-497(109/L) started at 14.2±16.3 days (ranged 2-100) after the onset of chemotherapy and resolved within 11.2±7.3 days either with (45.1%) or without (54.9%) granulocyte colony stimulating factor (G-CSF).No significant association could be found between any patient character or disease stage and the risk for CIN. However, certain malignancies (ALL, Neuroblastoma and Burkitt's lymphoma) and certain regimens (induction blocks for ALL, AML) had the worst myelotoxic effect with severe and prolonged neutropenia episodes. G-CSF significantly shortened the neutropenia episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complications among our cases (73.5%), associated with several documented infections particularly mucositis (54.9%), respiratory (45.1%), GIT (38.9%) and skin (23.9%) infections. 6% of our cases died of infection –related complications. Neutropenia was responsible for treatment discontinue (13.3%), dose delay (13.3%), and dose reduction (5.3%) of our patients. The mean cost for each episode in our service was 9386.5±6688.9 Egyptian pounds (L.E) which represented a significant burden on health care providers.
Summary
Although this study is preliminary survey with relatively small number of patients, our findings are relevant to clinical care of pediatric cancer patients in our region. Special attention to CIN prevention should be directed to hematologic malignancy cases especially at early cycles. Severe and prolonged neutropenia are life-threatening events that need aggressive management.
Keyword(s): Cancer, Chemotherapy, Neutropenia, Risk factor
Session topic: Publication Only