Bagnasco Francesca, Haupt Riccardo, Fontana Vincenzo, Valsecchi Maria Grazia, Rebora Paola, Caviglia Ilaria, Caruso Silvia, Castagnola Elio
Epidemiology and Biostatistics Section, Scientific Directorate, G. Gaslini Children's Hospital, Genoa, Italy.
J Chemother. 2012 Jun;24(3):155-60. doi: 10.1179/1973947812Y.0000000002.
Febrile neutropenia (FN) is a possible complication of antineoplastic chemotherapy. Aim of the study was to estimate the risk of developing fever at the beginning of any neutropenic period based on the previous history of FN.
The conditional frailty model was used to estimate the risk of developing fever during neutropenia separately for children with acute leukaemia/non-Hodgkin lymphoma (AL/NHL), or solid tumour (ST). The total number of previous FN episodes (PFNE), age, gender, type of tumour, calendar year of granulocytopenic period, phase of treatment, and granulocyte count were included in the model.
A total of 901 granulocytopenic periods was observed in 223 children: 306 in 66 AL/NHL and 595 in 157 ST. Fever developed in 328 cases: 125 in 53 AL/NHL and 203 in 92 ST. The PFNE variable was not significantly associated to the risk of fever [hazard ratio (HR) of 0.87, 95% confidence interval (CI) of 0.62-1.22 in children with AL/NHL, and HR of 0.98, 95% CI of 0.70-1.37 in those with ST]. The hazard of FN was significantly affected by the phase of treatment in AL/NHL (P<0.01), and by the level of neutropenia at onset in ST (P<0.01).
Previous history of FN does not increase the risk of further febrile episodes in any new subsequent granulocytopenic period. The aggressiveness of chemotherapy and the level of neutropenia at onset are the most important risk factors in children with AL/NHL and with ST respectively.
发热性中性粒细胞减少症（FN）是抗肿瘤化疗可能出现的并发症。本研究的目的是根据既往FN病史评估在任何中性粒细胞减少期开始时发热的风险。
采用条件脆弱模型分别估计急性白血病/非霍奇金淋巴瘤（AL/NHL）或实体瘤（ST）患儿中性粒细胞减少期间发热的风险。模型纳入既往FN发作总数（PFNE）、年龄、性别、肿瘤类型、粒细胞缺乏期的日历年、治疗阶段和粒细胞计数。
共观察到223例患儿的901个粒细胞缺乏期：66例AL/NHL患儿中有306个，157例ST患儿中有595个。328例出现发热：53例AL/NHL患儿中有125例，92例ST患儿中有203例。PFNE变量与发热风险无显著相关性[AL/NHL患儿的风险比（HR）为0.87，95%置信区间（CI）为0.62 - 1.22；ST患儿的HR为0.98，95%CI为0.70 - 1.37]。AL/NHL的治疗阶段（P<0.01）和ST发病时的中性粒细胞减少水平（P<0.01）对FN的风险有显著影响。
既往FN病史不会增加随后任何新的粒细胞缺乏期进一步发热发作的风险。化疗的强度和发病时的中性粒细胞减少水平分别是AL/NHL患儿和ST患儿最重要的风险因素。
