Febrile Episodes during Chemotherapy Induced Neutropenia in Children with Acute Lymphoblastic Leukemia at Children Hospital –Benghazi 2013-2014

Patients undergoing chemotherapy are vulnerable to infection because of immunosuppression and prolonged hospitalizations. Chemotherapy drugs affect neutrophil production through myelosuppression (1) and low inflammatory response so that fever maybe the manifestation of infection (2).

The purpose of this study was to analyze febrile neutropenic episodes associated with infections in the 1st three phases of acute lymphoblastic leukemia (ALL) treatment, document the risk factors affecting morbidity, mortality, treatment and the outcome of treatment.

The study was a cross-sectional hospital-based descriptive survey in the Hematology-Oncology Unit at Children’s Hospital. It included all cases of (ALL) who were diagnosed within two years and treated with the Berlin Frankfurt Munich (BFM) protocol who developed fever during a neutropenic period. Data was recorded as gender, age, residence, nationality, number of episodes per patient, treatment phase, admission duration, length of stay (LOS) per episode, symptoms, physical examination and severity of fever. Investigations, the antibiotic used and the outcome were also recorded.

A total 27children, males accounting for 63%, 67<5 were included in the study. Febrile neutropenic episodes ranged 1–12. Their peak was in January. 40% were in phase II. LOS range 2-35 days. Fever showed a median of 38.8 °C, higher in phase II and III. Admission and therapy phases were longer in children ˂ 2 years old and in males. The neutrophil median was 270/mm3. Stomatitis was seen in70% of episodes, gastroenteritis in 65%, fever of unknown origin (FUO) in 16%and pneumonias in 15%. 20/23 bacterial infections were Gram-negative. 40% of episodes required a change of antibiotics. The mortality rate was 22%.