Israëls Trijn, van de Wetering Marianne D, Hesseling Peter, van Geloven Nan, Caron Huib N, Molyneux Elizabeth M
Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.
Pediatr Blood Cancer. 2009 Jul;53(1):47-52. doi: 10.1002/pbc.22032.
Infection in neutropenic children is a major cause of morbidity and mortality in children treated for cancer. In developing countries, children with cancer are often malnourished at diagnosis. In Blantyre, Malawi, children with Burkitt lymphoma are treated with a local protocol with limited toxicity. The aim of this study was to evaluate the incidence and outcome of febrile neutropenia during this treatment and the association with malnutrition at diagnosis.
We documented nutritional status, febrile and/or neutropenic episodes, antibiotic therapy and short term outcome of all children with Burkitt lymphoma treated according to the local protocol and admitted from January 2007 to March 2008.
Fifty eight (69%) of 84 patients were acutely malnourished at diagnosis with an arm muscle area (AMA) below the 5(th) percentile. Malnutrition at diagnosis was associated with a significantly higher rate of profound neutropenia. This association remained significant (OR 12; 95% C.I. 1.5 - infinitely; P = 0.012) after control for clinical stage of disease, bone marrow involvement and HIV infection which are possible confounders. All patients with profound neutropenia, prolonged neutropenia and treatment related deaths were malnourished at diagnosis. Four (4.9%) of 81 patients died of treatment related causes; three of them due to a Gram negative septicaemia.
Acute malnutrition at diagnosis is associated with significantly more treatment related profound neutropenia. The intensity of chemotherapeutic regimens has to be adapted to the level of available supportive care and patients' nutritional status and tolerance to avoid unacceptable morbidity and mortality. This local treatment protocol for Burkitt lymphoma has a treatment related mortality of 5% in patients in Malawi.
中性粒细胞减少的儿童发生感染是癌症治疗儿童发病和死亡的主要原因。在发展中国家，癌症患儿在确诊时往往营养不良。在马拉维的布兰太尔，伯基特淋巴瘤患儿采用局部方案治疗，毒性有限。本研究的目的是评估该治疗期间发热性中性粒细胞减少的发生率和结局，以及与确诊时营养不良的相关性。
我们记录了2007年1月至2008年3月期间按照局部方案治疗并入院的所有伯基特淋巴瘤患儿的营养状况、发热和/或中性粒细胞减少发作、抗生素治疗及短期结局。
84例患者中有58例（69%）在确诊时严重营养不良，上臂肌肉面积（AMA）低于第5百分位数。确诊时的营养不良与严重中性粒细胞减少的发生率显著较高相关。在控制了疾病临床分期、骨髓受累和HIV感染这些可能的混杂因素后，这种相关性仍然显著（比值比12；95%可信区间1.5 - 无穷大；P = 0.012）。所有发生严重中性粒细胞减少、持续性中性粒细胞减少及治疗相关死亡的患者在确诊时均营养不良。81例患者中有4例（4.9%）死于治疗相关原因；其中3例死于革兰阴性菌败血症。
确诊时的急性营养不良与显著更多的治疗相关严重中性粒细胞减少有关。化疗方案的强度必须根据可用支持治疗的水平以及患者的营养状况和耐受性进行调整以避免不可接受的发病率和死亡率。在马拉维，这种伯基特淋巴瘤的局部治疗方案在患者中的治疗相关死亡率为5%。
