Pediatrik onkolojide febril nötropenili hastalarda risk gruplarının değerlendirilmesi
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Date
2007
Authors
Özgür, Taner
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Son yıllarda çocukluk çagı kanserlerinin tanı ve tedavilerinde meydana gelen olumlu gelismelerle bu hastalıkların prognozlarında dramatik bir iyilesme saglanmasına karsın, bu hasta populasyonunda enfeksiyonlar önemli morbidite ve mortalite nedeni olmaya devam etmektedir. Geçen sürede bulunan çok sayıda yeni antibiyotik ve destek tedavilerinde büyük gelismelere karsın son yıllarda daha yogun kemoterapi protokollerinin yaygın kullanımı nedeniyle enfeksiyona baglı morbidite ve mortalite oranları degismemistir. Kanserli hastada gelisen her enfeksiyon atagı antikanser tedavide aksamaya neden olarak yasam oranlarını olumsuz yönde etkilemekte ve toplam tedavi maliyetini arttırmaktadır. Bu retrospektif çalısmanın amacı Uludag Üniversitesi Tıp Fakültesi Pediatrik Onkoloji Bilim Dalında takip ve tedavi edilen kanserli çocuklarda 2000-2005 yılları arasında gelisen atesli nötropeni ataklarının özelliklerinin ve risk faktörlerinin degerlendirilmesidir. Ocak 2000 – Aralık 2005 tarihleri arasında atesli nötropeni tanısı ile hastaneye yatırılan 15 kız (%26,3) ve 42 erkek (%73,7), toplam 57 hastadan 206 atak incelendi. Hastaların yas, tanı, demografik özellikleri ve sosyoekonomik durumları degerlendirildi. Hastaneye yatıs anında bakılan mutlak nötrofil sayısı (MNS), mutlak monosit sayısı (MMS), mutlak lenfosit sayısı (MLS), Hb, CRP, Trombosit degerleri ve fizik muayenedeki enfeksiyon odakları kaydedildi. Hastaların izlemde ates süreleri, nötropeni süreleri, tedavi rejimleri, tedavi degisiklikleri, kültürlerde üreyen etkenler, tedavide basarı oranı ve mortalite oranı degerlendirildi. Bakteriyemi açısından risk faktörleri incelendi. Çalısmamızda atesli nötropenik hastaların tanıları incelendiginde en sık %26,3’ü NHL, %14’ü Osteosarkom, %12,3’ü Rabdomyosarkom ve %12,3’ü de Medulloblastom oldugu saptandı. Yatıs sırasında bakılan 5 ortalama MNS 296,5 ±342,4/mm3, MLS 518,9 ±896,7/mm3, MMS 144,3 ±262,0/mm3, CRP 7,63 ±7,06 mg/dl, Hb 8,67 ±1,74 g/dl, ates 38,5 ±0,2°C olarak bulundu. Atakların %57,3’ünde (n:118) enfeksiyon odagı yoktu, saptanan odaklar arasında en sık farenjit %14 (n:29) ve mukozit %12,1 (n:25) görüldü. Atakların %2,9’unda (n:6) monoterapi, %87,8’inde (n:181) 3.kusak sefalosporin ve aminoglikozid kombinasyonu uygulandı. Kan kültürlerinin %85,4’ünde (n:176) üreme saptanmadı, %14,6’sında (n:30) bakteriyemi görüldü. En sık üreyen bakteriler %16,7 E.coli, %13,3 Enterobacter cloaca, %13,3 S.epidermidis olarak bulundu. Tedavi basarı oranı %67,5 saptandı. Tanı anındaki enfeksiyon odagının, MNS, MMS, CRP degerleri ve mukozit varlıgı ile bakteriyemi arasında iliski saptanmadı. Atak sırasında mukozit varlıgının yatıs süresini uzattıgı görüldü. Tedavi rejimleri arasında tedavi basarısı, bakteriyemi ve yatıs süresi açısından anlamlı fark yoktu. Atakların %71,9’u (n:187) yogun kemoterapi alan tanı gruplarındaydı. Kemoterapi sonrası en erken NHL’li hastalarda atesli febril nötropeni gelistigi görüldü. Nötropeni süresinin NBL ve beyin tümörleri grubunda daha uzun oldugu saptandı. Mortalite oranı %1,45 bulundu. Sonuç olarak; bu çalısmada, kemoterapi yogunlugunun ve mukozitin atesli nötropenide yüksek riski belirleyen faktörlerden oldukları görüldü. Tüm atesli nötropenik hastalara yogun antibiyotik tedavisi verilmesinin mortalite riskini azalttıgı saptandı, ancak ilaç yan etkilerinin degerlendirilmesi için yeni çalısmalara ihtiyaç vardır.
The positive improvements in the diagnosis and treatment of childhood cancers have an dramatic effect on prognosis, but infections are still an important cause of morbidity and mortality in this patient population. Although many recent antibiotics and supportive therapies has been developed, the morbidity and mortality due to infections has not changed because intensive chemotherapy protocols has been widely used in recent years. Every infection attack in cancer patients hinderthe anti-cancer therapy and affect the survival rates negative and increase the cost of the therapy. The objective of this retrospective study was to evaluate the characteristics and risk factors of the febrile neutropenic attacks of the children who have cancer and who were followed up in Uludag University, Faculty of Medicine , Department of Pediatric Oncology Unit between 2000- 2005. Between January 2000 and December 2005, there were total 57 patients who were hospitalized for febrile neutropenia and 15 (26,3%) of them were female and 42 (73,7%) of them were male and they had 206 attacks. Age, gender, demographic features and socio-economic conditions of the patiens were reviewed. Absolute neutrophil count (ANC), absolute monocyte count (AMC), absolute lymphocyte count (ALC), Hb, CRP and platelet levels at the hospitalization time and the infection focus in physical examination were recorded. The durations of fever and neutropenia, therapy regimens, therapy modifications, agents isolated from cultures, the success rate of therapy and the mortality rates were also evaluated. Risk factors for bacteraemia were evaluated, too. 7 When we evaluated the diagnosis of the febrile neutropenic patients; 26,3%, 14%, 12,3% and 12,3% of them were NHL, osteosarcom, rhabdomyosarcom and medulloblastoma, respectively. The mean ANC, ALC, AMC levels at the time of hospitalization were 296,5 ±342,4/mm3, 518,9 ±896,7/mm3, 144,3 ±262,0/mm3, respectively. The mean CRP level was 7,63 ±7,06 mg/dL, Hb level was 8,67 ±1,74 g/dl and fever was 38.5 ±0,2°C. There were no infection focus in the 57,3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% (n=29) and 12,1% (n=25) of the attacks, respectively. Monotherapy was used in 2,9% (n=6) of the attacks and combination of third generation cephalosporins and aminoglycosides were used in 87,8% (n=181) of the patients. There were no agents isolated from blood cultures in 85,4% (n=176) of the attacks and bacteraemia was found in 14,6% (n=30) of them. The most common agents isolated were E.Coli, Enterobacter cloaca and S. Epidermidis in 16,7%, 13,3% and 13,3%, respectively. The success rate of therapy was found as 67,5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteraemia. The presence of mucositis proloned the duration of hospitalization. There were no significant differences between therapy regimens acoording to success of therapy success, bacteraemia and duration of hospitalization . The development of febrile neutropenia after chemotherapy was earlier in children with NHL. The duration of neutropenia were longer in NBL and brain tumors. The mortality rate was found as 1,45%. As a result, in this study the intensity of chemotherapy and mucositis were found to be the risk factors that determine the high risk in febrile neutropenia. We found that intensive antibiotic treatment given to all febrile neutropenic patients reduced the mortality risk but we suggest that further studies are needed to evaluate the side-effects of the therapies.
The positive improvements in the diagnosis and treatment of childhood cancers have an dramatic effect on prognosis, but infections are still an important cause of morbidity and mortality in this patient population. Although many recent antibiotics and supportive therapies has been developed, the morbidity and mortality due to infections has not changed because intensive chemotherapy protocols has been widely used in recent years. Every infection attack in cancer patients hinderthe anti-cancer therapy and affect the survival rates negative and increase the cost of the therapy. The objective of this retrospective study was to evaluate the characteristics and risk factors of the febrile neutropenic attacks of the children who have cancer and who were followed up in Uludag University, Faculty of Medicine , Department of Pediatric Oncology Unit between 2000- 2005. Between January 2000 and December 2005, there were total 57 patients who were hospitalized for febrile neutropenia and 15 (26,3%) of them were female and 42 (73,7%) of them were male and they had 206 attacks. Age, gender, demographic features and socio-economic conditions of the patiens were reviewed. Absolute neutrophil count (ANC), absolute monocyte count (AMC), absolute lymphocyte count (ALC), Hb, CRP and platelet levels at the hospitalization time and the infection focus in physical examination were recorded. The durations of fever and neutropenia, therapy regimens, therapy modifications, agents isolated from cultures, the success rate of therapy and the mortality rates were also evaluated. Risk factors for bacteraemia were evaluated, too. 7 When we evaluated the diagnosis of the febrile neutropenic patients; 26,3%, 14%, 12,3% and 12,3% of them were NHL, osteosarcom, rhabdomyosarcom and medulloblastoma, respectively. The mean ANC, ALC, AMC levels at the time of hospitalization were 296,5 ±342,4/mm3, 518,9 ±896,7/mm3, 144,3 ±262,0/mm3, respectively. The mean CRP level was 7,63 ±7,06 mg/dL, Hb level was 8,67 ±1,74 g/dl and fever was 38.5 ±0,2°C. There were no infection focus in the 57,3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% (n=29) and 12,1% (n=25) of the attacks, respectively. Monotherapy was used in 2,9% (n=6) of the attacks and combination of third generation cephalosporins and aminoglycosides were used in 87,8% (n=181) of the patients. There were no agents isolated from blood cultures in 85,4% (n=176) of the attacks and bacteraemia was found in 14,6% (n=30) of them. The most common agents isolated were E.Coli, Enterobacter cloaca and S. Epidermidis in 16,7%, 13,3% and 13,3%, respectively. The success rate of therapy was found as 67,5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteraemia. The presence of mucositis proloned the duration of hospitalization. There were no significant differences between therapy regimens acoording to success of therapy success, bacteraemia and duration of hospitalization . The development of febrile neutropenia after chemotherapy was earlier in children with NHL. The duration of neutropenia were longer in NBL and brain tumors. The mortality rate was found as 1,45%. As a result, in this study the intensity of chemotherapy and mucositis were found to be the risk factors that determine the high risk in febrile neutropenia. We found that intensive antibiotic treatment given to all febrile neutropenic patients reduced the mortality risk but we suggest that further studies are needed to evaluate the side-effects of the therapies.
Description
Keywords
Çocukluk çağı kanserleri, Atesli nötropeni, Risk faktörleri, Childhood cancers, Febrile neutropenia, Risk factors
Citation
Taner, Ö. (2007). Pediatrik onkolojide febril nötropenili hastalarda risk gruplarının değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.