title: A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation.
abstract: BACKGROUND
  The purpose of our study was to evaluate the incidence and clinical characteristics of febrile episodes during neutropenia following chemotherapy in children with cancer.
  
  
  METHODS
  A prospective, 3-year single-center observational study of periods of neutropenia was performed. Epidemiology and clinical diagnoses of febrile episodes occurring during the neutropenic periods were evaluated, taking into consideration different categories of anticancer treatment based on the type of tumor and phase of therapy.
  
  
  RESULTS
  A total of 703 febrile episodes were observed during 614 (34%) of 1792 neutropenic periods (34%), for a total of 28,001 days at risk, accounting for a rate of 0.76 episodes per 30 days at risk. The highest proportions of neutropenic periods with primary febrile episodes were observed after autologous hemopoietic stem cell transplantation (58%), aggressive treatment for acute leukemia or non-Hodgkin lymphoma (48%), and allogeneic hemopoietic stem cell transplantation (44%); the lowest proportion (9%) was observed during maintenance chemotherapy for acute leukemia (P<.001). The most frequent clinical diagnosis was fever of unknown origin (in 79% of cases), followed by bacteremia (10%); invasive mycosis was diagnosed in only 2% of cases.
  
  
  CONCLUSIONS
  The overall incidence of febrile neutropenia and severe infectious complications in children with cancer is low, with differences according to the aggressiveness of chemotherapy. This fact must be considered when designing clinical trials on the management of infectious complications in children with cancer.
authors.affiliation: Infectious Diseases Unit, G. Gaslini Children Hospital, Genoa, Italy. eliocastagnola@ospedale-gaslini.ge.it
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fontana
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caviglia
authors.forename: Silvia
authors.initials: S
authors.lastname: Caruso
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
authors.forename: Francesca
authors.initials: F
authors.lastname: Fioredda
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Garrè
authors.forename: Cristina
authors.initials: C
authors.lastname: Moroni
authors.forename: Massimo
authors.initials: M
authors.lastname: Conte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.forename: Franca
authors.initials: F
authors.lastname: Scuderi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bandettini
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009181:Mycoses / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D009503:Neutropenia / Q000150:complications*; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents