Infectious events in pediatric patients with acute lymphoblastic leukemia/lymphoma undergoing evaluation for fever without severe neutropenia

• Published in: Cancer Vol. 128; no. 23; pp. 4129 - 4138
• Main Authors: Patel, Pratik A., DeGroote, Nicholas P., Jackson, Kasey, Cash, Thomas, Castellino, Sharon M., Jaggi, Preeti, Esbenshade, Adam J., Miller, Tamara P.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2022
• Subjects: Acute Disease; Acute lymphoblastic leukemia; acute lymphoblastic lymphoma; Antibiotics; Bacteremia; Chills; Cytarabine; Fever; Fever - complications; Health services; Humans; Hypotension; Infections; Leukemia; Leukocytes (neutrophilic); Lymphatic leukemia; Lymphoma; Lymphoma - complications; Morbidity; Neutropenia; Neutropenia - chemically induced; Neutropenia - epidemiology; Oncology; Patients; Pediatrics; Phenotypes; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Respiratory Tract Infections; Risk Factors; Sepsis; infections; fever; acute lymphoblastic leukemia; acute lymphoblastic lymphoma; pediatrics
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34476

Background Infections cause significant treatment‐related morbidity during pediatric acute lymphoblastic leukemia/lymphoma (ALL/LLy) therapy. Fevers during periods without severe neutropenia are common, but etiologies are not well‐described. This study sought to describe the bloodstream infection (BSI) and non‐BSI risk in children undergoing therapy for ALL/LLy. Methods Demographic and clinical data were ed for febrile episodes without severe neutropenia at two children's hospitals. Treatment courses were stratified by intensity. Multivariate logistic regression evaluated characteristics associated with infection. Results There were 1591 febrile episodes experienced by 524 patients. Of these, 536 (34%) episodes had ≥1 infection; BSI occurred in 30 (1.9%) episodes. No BSIs occurred in episodes with a recent procedural sedation or cytarabine exposure. Presence of hypotension, chills/rigors, higher temperature, and infant phenotype were independently associated with BSI (p < .05). Of the 572 non‐BSIs, the most common was upper respiratory infection (URI) (n = 381, 67%). Compared to episodes without infection, URI symptoms, higher temperature, absolute neutrophil count 500−999/μl, and evaluation during a low‐intensity treatment course were more likely to be associated with a non‐BSI (p < .05) and inpatient status was less likely to be associated with a non‐BSI (p < .05). Conclusions The BSI rate in pediatric patients with ALL/LLy and fever without severe neutropenia is low, but one‐third of the time, patients have a non‐BSI. Future research should test if the need for empiric antibiotics can be tailored based on the associations identified in this study. Fever without severe neutropenia is common during treatment for pediatric acute lymphoblastic leukemia/lymphoma, but infectious etiologies are poorly described. This multi‐institution study demonstrates that the bloodstream infection rate is low, but one‐third of the time patients have a nonbloodstream infection identified.