Neutrophil regeneration precedes healing of tissue destruction, as indicated by serum C-reactive protein, in children with cancer recovering from neutropenic fever.
OBJECTIVE
To evaluate the relationship between absolute neutrophil count and C-reactive protein (CRP) in the recovery phase of neutropenic fever among paediatric patients with cancer.


METHODS
A total of 102 paediatric oncology patients with 177 episodes of fever and neutropenia was studied prospectively in a two-centre setting. Antimicrobial therapy was discontinued 9 d (mean) post-initiation with a mean absolute neutrophil count of 1.8 x 10(9) l(-1) and CRP of 32 mg l(-1).


RESULTS
The mean level of CRP below 20 mg l(-1) was reached on day 12. The level of CRP peaked on the day following the commencement of antimicrobial therapy. Throughout the episodes of fever and neutropenia higher levels of CRP were associated with a lower absolute neutrophil count. Following defervescence the pace of marrow recovery as evidenced by an increasing absolute neutrophil count to > 0.2 and > 0.5 x 10(9) l(-1) was more rapid than the normalization of serum CRP. There was a 2-3 d lag period between absolute neutrophil count exceeding the level of 200 x 10(6) l(-1) and the return of CRP to a baseline level. All episodes were treated successfully and there were no fatalities.


CONCLUSIONS
Among patients recovering from neutropenia and fever the signs of marrow recovery remain the key criterion in evaluating the safety of discontinuing antimicrobial therapy, with serum CRP remaining more of an indicator of ongoing tissue repair.
Vettenranta
K
K
Hospital for Children and Adolescents, University of Helsinki, Finland. kim.vettenranta@hus.fi
Hovi
L
L
Mäkipernaa
A
A
Jalanko
H
H
Saarinen-Pihkala
U M
UM
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000097:blood* / Q000139:chemically induced / Q000276:immunology*; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology*; D009503:Neutropenia / Q000097:blood* / Q000139:chemically induced / Q000276:immunology*; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012038:Regeneration / Q000276:immunology*; D014945:Wound Healing / Q000276:immunology*
D000970:Antineoplastic Agents; D002097:C-Reactive Protein