Current approaches for risk stratification of infectious complications in pediatric oncology.
Infections are serious complications of cytoreductive therapy in pediatric cancer patients presenting with febrile neutropenia. It is standard of care to initiate empirical intravenous broad-spectrum antibiotics until the fever and neutropenia resolve. However, it might be effective and safe to allow for early hospital discharge in certain subgroups of patients. Two strategies for risk stratification of pediatric cancer patients with regard to infectious complications are discussed in this review: (1) clinical risk parameters and laboratory measures to assist therapeutic management at presentation with fever in neutropenia, and (2) investigations of individual genetic susceptibility factors to tailor potential prophylactic approaches. Given the data available from a significant number of small studies, a large prospective non-inferiority trial is essential to assess low-risk clinical factors and additional laboratory or genetic markers for their predictive value.
Härtel
Christoph
C
Department of Pediatric Hematology, Oncology and Immunology, University of Lübeck, Childrens Hospital, Germany. haertel@paedia.ukl.mu-luebeck.de
Deuster
Maresa
M
Lehrnbecher
Thomas
T
Schultz
Christian
C
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D005819:Genetic Markers / Q000235:genetics; D020022:Genetic Predisposition to Disease; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000188:drug therapy / Q000209:etiology / Q000235:genetics / Q000378:metabolism; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism; D010351:Patient Discharge; D017751:Safety Management
D000900:Anti-Bacterial Agents; D005819:Genetic Markers