Paediatric Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
Ann Acad Med Singap. 2015 Nov;44(11):530-4.
Treatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.
Patients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.
There were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.
Febrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.
采用强化化疗治疗急性淋巴细胞白血病（ALL）已取得较高的治愈率，但也导致了大量发病率。感染并发症是治疗相关毒性的重要组成部分。本研究的目的是描述我们机构治疗 ALL 的患儿接受化疗诱导性发热性中性粒细胞减少症的微生物病因和临床结局。
采用 HKSGALL93 或马来西亚-新加坡（Ma-Spore）2003 化疗方案治疗 ALL 患者。回顾性分析 2000 年 6 月至 2010 年 1 月期间完成强化治疗（诱导、中枢神经系统（CNS）定向治疗至再诱导）的 197 例患者的记录。
197 例患者中共有 587 例发热性中性粒细胞减少症，每例患者的总发生率为 2.98 例。22.7%的病例中分离出了病原体。最常分离到的病原体为革兰氏阳性菌（36.4%）和革兰氏阴性菌（36.4%），其次为病毒病原体（17.4%）、真菌病原体（8.4%）和其他细菌（1.2%）。真菌病原体在需要入住高依赖或重症监护病房（23.1%）的发热性中性粒细胞减少症严重临床病例中占更高比例。所有病例的总体死亡率为 1.5%。
ALL 患者接受强化化疗后仍需关注发热性中性粒细胞减少症。大多数病例不会有明确的病原体。最常见的病原体为革兰氏阳性菌和革兰氏阴性菌。采用适当的抗菌治疗和支持性管理，发热性中性粒细胞减少症的总体死亡率非常低。
