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Clément L, Hélène D, Maud M, Chrystelle D, Constance B, Fréderic M, France R, Pilar GHM, José-Miguel TD, Blandine R. Safety of empirical antibiotic therapy discontinuing for fever of unknown origin during high-risk neutropenia in children. J Infect 2024; 88:106171. [PMID: 38697268 DOI: 10.1016/j.jinf.2024.106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND ECIL-2021 recommends discontinuing empirical antibiotic therapy (EAT) in febrile-neutropenic children after 72 h of treatment and at least 24-48 h of apyrexia in the case of fever of unknown origin (FUO). These guidelines are rarely applied to high-risk children's neutropenia. MATERIAL AND METHODS We retrospectively included all consecutive FUO episodes occurring during profound neutropenia ≥ 10 days in children in our institution. We evaluated the safety of EAT discontinuation in patients for whom the ECIL guidelines were followed compared to those for whom they didn't. We used a combined criterion of mortality and intensive care unit admission at 30 days. We identified risk factors for recurrent fever after EAT discontinuation. RESULTS Fifty-one FUO episodes occurred in 37 patients. EAT discontinuation followed ECIL guidelines in 19 (37 %) episodes. No deaths and-or transfers in ICU occurred in the ECIL group. The duration of EAT was shorter by nine days in the group following ECIL guidelines (p < 0.001). We observed 14 (27 %) episodes of recurrent fever. Mucositis was significantly associated with recurrent fever (p < 0.01). CONCLUSION EAT discontinuation seems feasible and safe in FUO during prolonged febrile neutropenia in children. However, mucosal lesions should prompt thorough surveillance due to the risk of recurrent fever.
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Affiliation(s)
- Lemaigre Clément
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France
| | - Deutch Hélène
- Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Meligne Maud
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Dupraz Chrystelle
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | | | - Millot Fréderic
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Roblot France
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; INSERM U1070, Poitiers, France
| | - Gallego-Hernanz Maria Pilar
- Service d'Oncologie Hématologique Et Thérapie Cellulaire, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Torregrosa-Diaz José-Miguel
- Service d'Oncologie Hématologique Et Thérapie Cellulaire, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Rammaert Blandine
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; INSERM U1070, Poitiers, France.
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Zhang M, Long X, Xiao Y, Jin J, Chen C, Meng J, Liu W, Liu A, Chen L. Assessment and predictive ability of the absolute neutrophil count in peripheral blood for in vivo CAR T cells expansion and CRS. J Immunother Cancer 2023; 11:e007790. [PMID: 38016717 PMCID: PMC10685953 DOI: 10.1136/jitc-2023-007790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T cell therapy is an advanced and effective immunotherapy for relapsed or refractory B-cell malignancies. High expansion of CAR T cells in vivo and durable antitumor activity indicate a persistent therapeutic response. However, this treatment is linked to a high frequency of adverse events, such as cytokine release syndrome (CRS), which affects its efficacy and can even be life-threatening. At present, a variety of markers associated with clinical response and treatment toxicity after CAR T cells infusion have been reported. Although these biomarkers can act as effective indicators reflecting CAR T cells expansion as well as CRS, they fail to predict the expansion rate of CAR T cells. Hence, further investigation is urgent to find a new biomarker to fill this void. METHODS We analyzed the association between the absolute neutrophil count (ANC) and CAR expansion and CRS in 45 patients with B-cell malignancies from two clinical trials. We proposed that ANC could be a practical biomarker for CAR T cells expansion and CRS, and conducted a feasibility analysis on its predictive ability. RESULTS In this study, 17 B-cell hematological malignancy patients with anti-B-cell maturation antigen CAR-treated and 28 with CAR19/22 T-cell-treated were enrolled and divided into an ANC-absence group and an ANC-presence group. The results showed that ANC absence correlated positively with CAR expansion and the expansion rate. The ANC can be used as a predictive marker for CAR T cells expansion. Moreover, the patients with ANC absence experienced a more severe CRS, and ANC performed a predictive ability for CRS. In addition, the peak serum concentration of several cytokines involved in CRS was higher in patients with ANC absence. CONCLUSION Thus, we suggest ANC as an evaluative and predictive biomarker for CAR expansion and CRS during CAR T cell therapy, which can help to maximize clinical efficacy, reduce treatment-related toxicity and prolong survival.
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Affiliation(s)
- Man Zhang
- Department of Hematology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaolu Long
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jin Jin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Hematology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Caixia Chen
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiao Meng
- Department of Hematology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wanying Liu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aichun Liu
- Department of Hematology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Liting Chen
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Martínez Campos L, Pérez-Albert P, Ferres Ramis L, Rincón-López EM, Mendoza-Palomar N, Soler-Palacin P, Aguilera-Alonso D. Consensus document on the management of febrile neutropenia in paediatric haematology and oncology patients of the Spanish Society of Pediatric Infectious Diseases (SEIP) and the Spanish Society of Pediatric Hematology and Oncology (SEHOP). An Pediatr (Barc) 2023:S2341-2879(23)00111-4. [PMID: 37268527 DOI: 10.1016/j.anpede.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/24/2023] [Indexed: 06/04/2023] Open
Abstract
Febrile neutropenia is one of the main infectious complications experienced by paediatric patients with blood or solid tumours, which, despite the advances in diagnosis and treatment, are still associated with a significant morbidity and mortality. These patients have several risk factors for infection, chief of which are chemotherapy-induced neutropenia, the disruption of cutaneous and mucosal barriers and the use of intravascular devices. Early diagnosis and treatment of febrile neutropenia episodes based on the patient's characteristics is essential in patients with blood and solid tumours to improve their outcomes. Therefore, it is important to develop protocols in order to optimise and standardise its management. In addition, the rational use of antibiotics, with careful adjustment of the duration of treatment and antimicrobial spectrum, is crucial to address the increase in antimicrobial drug resistance. The aim of this document, developed jointly by the Spanish Society of Pediatric Infectious Diseases and the Spanish Society of Pediatric Hematology and Oncology, is to provide consensus recommendations for the management of febrile neutropenia in paediatric oncology and haematology patients, including the initial evaluation, the stepwise approach to its treatment, supportive care and invasive fungal infection, which each facility then needs to adapt to the characteristics of its patients and local epidemiological trends.
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Affiliation(s)
| | - Paula Pérez-Albert
- Servicio de Oncología y Hematología Pediátricas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laia Ferres Ramis
- Servicio de Oncohematología Pediátrica, Hospital Universitario Son Espases, Palma, Mallorca, Spain
| | - Elena María Rincón-López
- Sección Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Área de Enfermedades Infecciosas Pediátricas, Centro de Investigación Biomédica en Red del Instituto de Salud Carlos III (CIBERINFEC), Madrid, Spain
| | - Natalia Mendoza-Palomar
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de investigación «Infección e inmunidad en el paciente pediátrico», Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Pere Soler-Palacin
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de investigación «Infección e inmunidad en el paciente pediátrico», Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Pediatría, Obstetricia y Ginecología y de Medicina Preventiva y Salud Pública, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Aguilera-Alonso
- Sección Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Área de Enfermedades Infecciosas Pediátricas, Centro de Investigación Biomédica en Red del Instituto de Salud Carlos III (CIBERINFEC), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Wattier RL, Esbenshade AJ. From "More is Better" to "Less is More": A Commentary on Antimicrobial Use in Pediatric Oncology. J Pediatric Infect Dis Soc 2022; 11:229-238. [PMID: 35099542 DOI: 10.1093/jpids/piab111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022]
Abstract
Reducing avoidable antimicrobial exposure to pediatric patients with cancer is achievable and necessary to promote optimal short- and long-term outcomes. Multiple evidence-based practices are already well established but should be more consistently implemented. Important opportunities exist to further improve the evidence to guide selective antimicrobial use in pediatric oncology.
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Affiliation(s)
- Rachel L Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
| | - Adam J Esbenshade
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee, USA
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