Neutropenia and Infection Prophylaxis in Childhood Cancer

Overview

Journal Curr Oncol Rep

Publisher Current Science

Specialty Oncology

Date 2022 Mar 1

PMID 35230594

Authors

Stephanie Villeneuve

Catherine Aftandilian

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Pediatric oncology patients frequently experience episodes of prolonged neutropenia which puts them at high risk for infection with significant morbidity and mortality. Here, we review the data on infection prophylaxis with a focus on both pharmacologic and ancillary interventions. This review does not include patients receiving hematopoietic stem cell transplantation.

Recent Findings: Patients with hematologic malignancies are at highest risk for infection. Bacterial and fungal prophylaxis decrease the risk of infection in certain high-risk groups. Ancillary measures such as ethanol locks, chlorhexidine gluconate baths, GCSF, IVIG, and mandatory hospitalization do not have enough data to support routine use. There is limited data on risk of infection and role of prophylaxis in patients receiving immunotherapy and patients with solid tumors. Patients with Down syndrome and adolescent and young adult patients may benefit from additional supportive care measures and protocol modifications. Consider utilizing bacterial and fungal prophylaxis in patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. More research is needed to evaluate other supportive care measures and the role of prophylaxis in patients receiving immunotherapy.

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References

Hunger S, Lu X, Devidas M, Camitta B, Gaynon P, Winick N . Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group. J Clin Oncol. 2012; 30(14):1663-9. PMC: 3383113. DOI: 10.1200/JCO.2011.37.8018. View

Rickard C, Ullman A . Bloodstream infection and occlusion of central venous catheters in children. Lancet Infect Dis. 2018; 18(8):815-817. DOI: 10.1016/S1473-3099(18)30267-6. View

Schoot R, van Ommen C, Stijnen T, Tissing W, Michiels E, Abbink F . Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial. Eur J Cancer. 2015; 51(14):2031-8. DOI: 10.1016/j.ejca.2015.06.126. View

Gurion R, Belnik-Plitman Y, Gafter-Gvili A, Paul M, Vidal L, Ben-Bassat I . Colony-stimulating factors for prevention and treatment of infectious complications in patients with acute myelogenous leukemia. Cochrane Database Syst Rev. 2012; (6):CD008238. PMC: 7390444. DOI: 10.1002/14651858.CD008238.pub3. View

Vijenthira A, Gong I, Fox T, Booth S, Cook G, Fattizzo B . Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood. 2020; 136(25):2881-2892. PMC: 7746126. DOI: 10.1182/blood.2020008824. View

OConnor D, Bate J, Wade R, Clack R, Dhir S, Hough R . Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003. Blood. 2014; 124(7):1056-61. DOI: 10.1182/blood-2014-03-560847. View

Buitenkamp T, Izraeli S, Zimmermann M, Forestier E, Heerema N, van den Heuvel-Eibrink M . Acute lymphoblastic leukemia in children with Down syndrome: a retrospective analysis from the Ponte di Legno study group. Blood. 2013; 123(1):70-7. PMC: 3879907. DOI: 10.1182/blood-2013-06-509463. View

Goossen G, Kremer L, van de Wetering M . Influenza vaccination in children being treated with chemotherapy for cancer. Cochrane Database Syst Rev. 2013; (8):CD006484. PMC: 6466690. DOI: 10.1002/14651858.CD006484.pub3. View

Proudfoot R, Phillips B, Wilne S . Guidelines for the Prophylaxis of Pneumocystis jirovecii Pneumonia (PJP) in Children With Solid Tumors. J Pediatr Hematol Oncol. 2017; 39(3):194-202. DOI: 10.1097/MPH.0000000000000771. View

10.

Fisher B, Robinson P, Lehrnbecher T, Steinbach W, Zaoutis T, Phillips B . Risk Factors for Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review. J Pediatric Infect Dis Soc. 2017; 7(3):191-198. DOI: 10.1093/jpids/pix030. View

11.

Lehrnbecher T, Averbuch D, Castagnola E, Cesaro S, Ammann R, Garcia-Vidal C . 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 2021; 22(6):e270-e280. DOI: 10.1016/S1470-2045(20)30725-7. View

12.

Reilly A, Kersun L, McDonald K, Weinberg A, Jawad A, Sullivan K . The efficacy of influenza vaccination in a pediatric oncology population. J Pediatr Hematol Oncol. 2010; 32(5):e177-81. DOI: 10.1097/MPH.0b013e3181d869f3. View

13.

Lehrnbecher T, Zimmermann M, Reinhardt D, Dworzak M, Stary J, Creutzig U . Prophylactic human granulocyte colony-stimulating factor after induction therapy in pediatric acute myeloid leukemia. Blood. 2006; 109(3):936-43. DOI: 10.1182/blood-2006-07-035915. View

14.

Kotecha R, Wadia U, Jacoby P, Ryan A, Blyth C, Keil A . Immunogenicity and clinical effectiveness of the trivalent inactivated influenza vaccine in immunocompromised children undergoing treatment for cancer. Cancer Med. 2015; 5(2):285-93. PMC: 4735770. DOI: 10.1002/cam4.596. View

15.

Hassler A, Bochennek K, Gilfert J, Perner C, Schoning S, Creutzig U . Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML-BFM 2004. Pediatr Blood Cancer. 2016; 63(6):1070-4. DOI: 10.1002/pbc.25917. View

16.

van Tilburg C, Bierings M, Berbers G, Wolfs T, Pieters R, Bloem A . Impact of treatment reduction for childhood acute lymphoblastic leukemia on serum immunoglobulins and antibodies against vaccine-preventable diseases. Pediatr Blood Cancer. 2011; 58(5):701-7. DOI: 10.1002/pbc.23258. View

17.

Hakim H, Allison K, Van de Velde L, Tang L, Sun Y, Flynn P . Immunogenicity and safety of high-dose trivalent inactivated influenza vaccine compared to standard-dose vaccine in children and young adults with cancer or HIV infection. Vaccine. 2016; 34(27):3141-3148. PMC: 4899146. DOI: 10.1016/j.vaccine.2016.04.053. View

18.

Sykes A, Gerhardt E, Tang L, Adderson E . The Effectiveness of Trivalent Inactivated Influenza Vaccine in Children with Acute Leukemia. J Pediatr. 2017; 191:218-224.e1. PMC: 5726795. DOI: 10.1016/j.jpeds.2017.08.071. View

19.

Lehrnbecher T, Fisher B, Phillips B, Beauchemin M, Carlesse F, Castagnola E . Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients. J Clin Oncol. 2020; 38(27):3205-3216. PMC: 7499615. DOI: 10.1200/JCO.20.00158. View

20.

Laoprasopwattana K, Khwanna T, Suwankeeree P, Sujjanunt T, Tunyapanit W, Chelae S . Ciprofloxacin reduces occurrence of fever in children with acute leukemia who develop neutropenia during chemotherapy. Pediatr Infect Dis J. 2012; 32(3):e94-8. DOI: 10.1097/INF.0b013e3182793610. View