Febrile neutropenia in children with lymphoma and solid tumors: One center experience

Aim: The objective of this study is to evaluate the febrile neutropenia attacks in the children who have been treated for cancer in our center. Material and Method: Between January 2000 and December 2005, 57 patients with lymphoma and solid organ tumors who, had a total of 206 attacks of febril neutropenia were evaluated retrospectively. Results: The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296 +/- 342/mm(3), 518 +/- 896/mm(3), 144 +/- 262/mm(3), respectively. The mean C-reactive protein (CRP) level was 7.63 +/- 7.06 mg/dL, Hb level was 8.67 +/- 1.74 g/dL and fever was 38.5 +/- 0.2 degrees C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions: The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination.