Risk assessment in fever and neutropenia in children with cancer: What did we learn?
Children with cancer treated with chemotherapy are susceptible to bacterial infections and serious infectious complications. However, fever and neutropenia can also result from other causes, for which no antibiotic treatment is needed. In the past decades attempts have been made to stratify the heterogeneous group of pediatric cancer patients with fever and neutropenia into high- and low-risk groups for bacterial infections or infectious complications. Strategies for risk assessment have resulted in treatment regimens with early discharge or even no hospital admission at all, and/or treatment with oral or no antibiotics. We will provide a historical overview of the changing approach to low-risk fever and neutropenia, and we will also try to identify clear and objective parameters for risk assessment strategies and illustrate their relationship to innate immunity. In the future, new insights into genetic susceptibility on neutropenic fever might be of use in children with cancer with fever and neutropenia.
te Poele
Esther M
EM
Department of Pediatrics, Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
Tissing
Wim J E
WJ
Kamps
Willem A
WA
de Bont
Eveline S J M
ES
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics* / Q000276:immunology; D002648:Child; D005334:Fever / Q000139:chemically induced* / Q000276:immunology; D020022:Genetic Predisposition to Disease; D006801:Humans; D007113:Immunity, Innate; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents