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

• Type of Material: Article
• Authors: Pratik A. Patel, Emory University; Nicholas P. DeGroote, Children's Healthcare of Atlanta; Kasey Jackson, Monroe Carell Jr. Children's Hospital at Vanderbilt; Thomas Cash, Emory University; Sharon M. Castellino, Emory University; Preeti Jaggi, Emory University; Adam J. Esbenshade, Monroe Carell Jr. Children's Hospital at Vanderbilt; Tamara Miller, Emory University
• Language: English
• Date: 2022-10-13
• Publisher: John Wiley and Sons
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Cancer Society.
• Final Published Version (URL): https://doi.org/10.1002/cncr.34476
• Title of Journal or Parent Work: Cancer
• Volume: 128
• Issue: 23
• Start Page: 4129
• End Page: 4138
• Grant/Funding Information: Funding was provided by National Cancer Institute (5K07CA211956) and the National Heart, Lung, and Blood Institute (T32HL139443).
• Keywords: fever; pediatrics; acute lymphoblastic leukemia; acute lymphoblastic lymphoma; infections
• Research Categories: Biology, Microbiology; Health Sciences, Oncology

Abstract

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 abstracted 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.