Evaluation of febrile neutropenia attacks in patients with acute leukemia and solid tumors

Febrile neutropenia is one of the most common complications of myelosuppressive chemotherapy. It is among the leading causes of hospitalization in children with cancer. In this study, it was aimed to evaluate the febrile neutropenia (FN) attacks of patients followed up in our hospital with the diagnosis of acute leukemia and solid tumor in terms of clinical features, laboratory findings, treatments applied and treatment results. Between January 2012 and November 2021, 242 FN attacks of 95 patients aged 1 month to 18 years who were followed up and treated for cancer in Aydın Adnan Menderes University Hospital Pediatric Hematology-Oncology Clinic were retrospectively analyzed from their file records. Demographic characteristics of the patients, cancer diagnosis and treatment information, physical examination findings, laboratory parameters, fever and neutropenia durations during the attack, fever focus and microorganisms grown in the culture, imaging information, antimicrobial treatments applied, and intensive care need were recorded in a standard form. The median age of the patients included in the study was 7.9 (1-17), with 45.2% ALL, 41.1% solid tumors and 13.7% AML. The most common FN attack was seen during acute leukemia induction treatment with a rate of 57%. 65.3% of the patients applied to the hospital from home, and 46.7% had no complaints other than fever. While no signs were found in 32.4% of the patients on physical examination, 42.3% had mucositis, 26.6% had hyperemia/discharge at the catheter site, and 16% had pathology in respiratory sounds. During the FN attack, the mean ANC was 193/mm³ (0-1000), and the mean CRP was 47.1 mg/L (maximum: 312). CRP was found to be statistically significantly higher in the group of patients who died. (p<0.05) Bacteremia rate was found to be 32% in the blood cultures taken. The most reproducing microorganism % 24,1 rate of coagulase negative staphylococci. At the onset of the attack, empirical antibiotic therapy was initiated as monotherapy in 74% of the patients. Piperacillin-tazobactam was used as monotherapy at a rate of 58.3%, and a piperacillin-tazobactam and glycopeptide combination was used at a rate of 11.6% as a combined therapy. Chemotherapy was delayed due to 83 (34.7%) FN attacks. The mean chemotherapy delay time was found to be 8.8 days (2-48 days). While sepsis and/or multi-organ failure were present in 11 FN attacks (4.5%), the need for intensive care was seen in 8 FN attacks (3.3%), and inotropic use was observed in 22 FN attacks (9.1%). Seven patients (7.3%) died due to neutropenic sepsis. All of the deceased patients had bacteremia. Febrile neutropenia continues to be an important cause of mortality in childhood cancers. It is important to initiate rapid empirical antimicrobial therapy under the guidance of national and international guidelines. With this study, we think that the 10-year retrospective data of our center will contribute to the national data. Key Words: Bacteremia, Cancer, Febrile neutropenia, Leukemia.