Características de la leucemia linfoblástica aguda y neutropenia febril en niños y adolescentes atendidos en un hospital de Guayaquil, Ecuador

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Abstract

RESUMEN Con el objetivo de caracterizar clínicamente a los niños y adolescentes con leucemia linfoblástica aguda y neutropenia febril en un hospital de Ecuador se realizó un estudio de serie de casos revisando historias clínicas de pacientes atendidos en el Hospital de la Sociedad de Lucha Contra el Cáncer de la ciudad de Guayaquil durante enero 2014 y abril 2016. De los 101 pacientes 51,5% eran mujeres, la edad promedio fue 5,5±2,1 años, el 72,3% tenían riesgo alto de infección bacteriana invasora, el foco de origen infeccioso más frecuente fue el respiratorio con 47,5%, el 18,8% de los microorganismos aislados en hemocultivos fueron Gram-positivos. El 25,7% de los pacientes fallecieron, siendo la refractariedad a la quimioterapia uno de los factores asociados (p<0,001). En conclusión, la mortalidad en niños y adolescentes, con leucemia linfoblástica aguda y neutropenia febril fue elevada; siendo la refractariedad a la quimioterapia uno de los principales factores asociados.

Translated abstract

ABSTRACT With the objective of performing a clinical characterization of children and adolescents with acute lymphoblastic leukemia and febrile neutropenia in a hospital in Ecuador, a case series study was carried out, which involved reviewing the clinical records of patients receiving care at "Hospital de la Sociedad de Lucha Contra el Cancer" in Guayaquil between January 2014 and April 2016. Out of the 101 patients, 51.5% were female; mean age was 5.5±2.1 years old; 72.3% were at high risk for invasive bacterial infection; the most common infections were respiratory with 47.5%; 18.8% of bacteria isolated in blood cultures were Gram-positive. Finally, 25.7% of patients died, with chemotherapy resistance as one of the associated factors.

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Most cited references 22

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Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.

Antonio Sérgio Petrilli, Lillian Sung, Theoklis Zaoutis … (2012)

To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN). The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations. Recommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented. This guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.

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Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy.

Walter Linde-Zwirble, Vincent Caggiano, Timothy S Rickert … (2005)

Neutropenia is a common side effect of chemotherapy, often requiring hospitalization for treatment of severe cases. Neutropenia hospitalization (NH) rates have been reported in individual studies, but national estimates are needed. Chemotherapy-induced NHs were identified in the 1999 hospital discharge data bases from 7 states. Cancer and chemotherapy prevalence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and the National Cancer Data Base were used to calculate national NH rates for 13 cancer types. NH cost was estimated by multiplying charges by institution-specific, cost-to-charge ratios from the 1999 Centers for Medicare and Medicaid Services Hospital Cost Report. NH incidence was projected to national levels using population data from the United States Census and the Centers for Disease Control and Prevention. There were 20,780 discharges with documentation of cancer, chemotherapy, and neutropenia identified. Projecting to national levels, NH incidence was estimated at 60,294 cases (7.83 cases per 1000 cancer patients). The mean NH cost was 13,372 dollars. The mortality rate among patients with NH was estimated at 6.8% or 1 death for every 14 hospitalized patients. Among 13 selected cancer types, the NH rate was 34.20 cases per 1000 patients receiving chemotherapy (1 in 29 patients). NH was particularly common in patients with hematologic tumors, with an incidence of 43.3 cases per 1000 patients with such tumors (1 in 23 patients). The average NH cost for hematologic malignancies was 20,400 dollars, more than double the cost of NH for solid tumors. According to the current study, NH affects > 60,000 patients with cancer each year in the United States, with an average cost of 13,372 dollars per hospitalization and an associated inpatient mortality rate of 6.8%. (c) 2005 American Cancer Society.

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Length of stay and mortality associated with febrile neutropenia among children with cancer.

Christopher H Lyman, S. Basu, Valentina I Fernandez … (2005)

The aim of this study was to evaluate risk factors for longer length of stay (los) and mortality among hospitalized children with cancer who have febrile neutropenia. This study involved analysis of longitudinal data from the University HealthSystem Consortium database from 1995 to 2002. All patients who were 21 years or younger, with diagnostic codes for both neoplastic disease and febrile neutropenia at discharge, were included. A total of 12,446 patients were identified for the study. The los was 5 days or less for 6,799 patients, and greater than 5 days for 5,647 patients. The mortality rate was 3%. On bivariate analysis, race, age, cancer type, and associated complications (bacteremia/sepsis, hypotension, pneumonia, and fungal infections) were significantly associated with longer length of stay and death. On multivariate analysis, age group, race, cancer type (acute myeloid leukemia, multiple cancers v acute lymphoblastic leukemia), and the complication variables were significantly associated with increased risk of longer los and death. Certain types of cancer (Hodgkin's disease, osteosarcoma/Ewing's sarcoma, rhabdomyosarcoma, compared with acute lymphoblastic leukemia) and year of discharge after 1995 were significantly associated with a reduced risk of longer length of stay and/or mortality. Race, age group, year of discharge, associated complications, and cancer type were significantly associated with risk of longer los and mortality. These factors may potentially help in identifying high-risk patients who might benefit from targeted antibiotic therapy or prophylactic hematopoietic growth factor support.

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Author and article information

Contributors

Lissette Fuentes: Role: ND

María Flores: Role: ND

Adriana Iglesias: Role: ND

Adriana Luzuriaga: Role: ND

Nataly Rendón: Role: ND

Robert Ordoñez: Role: ND

Fanny Solórzano: Role: ND

Roberto Añez: Role: ND

Journal

Journal ID (publisher-id): rins

Title: Revista Peruana de Medicina Experimental y Salud Publica

Abbreviated Title: Rev. perú. med. exp. salud publica

Publisher: Instituto Nacional de Salud (Lima, , Peru )

ISSN (Print): 1726-4634

Publication date (Print and electronic): June 2018

Volume: 35

Issue: 2

Pages: 272-278

Affiliations

[2] Maracaibo orgnameUniversidad del Zulia orgdiv1Facultad de Medicina orgdiv2Centro de Investigaciones Endocrino - Metabólicas - «Dr. Félix Gómez» Venezuela

[1] Guayas orgnameUniversidad de Especialidades Espíritu Santo Ecuador

Article

Publisher ID: S1726-46342018000200272

DOI: 10.17843/rpmesp.2018.352.2862

SO-VID: 38c7fb6a-ed25-473f-a52b-d8c913b714f3

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date accepted : 21 February 2018

Date received : 05 May 2017

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Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 7

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SciELO Public Health

Keywords: Mortality,Sepsis,Cancer,Child,Mortalidad,Cáncer,Niños,Febrile neutropenia,Lymphoblastic leukemia,Neutropenia febril,Leucemia linfoblástica

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Keywords: Mortality, Sepsis, Cancer, Child, Mortalidad, Cáncer, Niños, Febrile neutropenia, Lymphoblastic leukemia, Neutropenia febril, Leucemia linfoblástica

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Most cited references 22

Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.

Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy.

Length of stay and mortality associated with febrile neutropenia among children with cancer.

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