Chemotherapy‑induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences

  • Authors:
    • Mohamed Badr
    • Tamer Hassan
    • Hanan Sakr
    • Nehad Karam
    • Doaa Abdel Rahman
    • Doaa Shahbah
    • Marwa Zakaria
    • Sahbaa Fehr
  • View Affiliations

  • Published online on: July 12, 2016     https://doi.org/10.3892/mco.2016.957
  • Pages: 300-306
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Abstract

Chemotherapy-induced neutropenia (CIN) is the major dose‑limiting toxicity of systemic chemotherapy and it is associated with significant morbidity, mortality and treatment cost. The aim of the present study was to identify the risk factors that may predispose pediatric cancer patients who receive myelosuppressive chemotherapy to CIN and associated sequelae. A total of 113 neutropenia episodes were analyzed and the risk factors for CIN were classified as patient‑specific, disease‑specific and regimen‑specific, while the consequences of CIN were divided into infectious and dose‑modifying sequelae. The risks and consequences were analyzed to target high‑risk patients with appropriate preventive strategies. Among our patients, 28% presented with a single neutropenia attack, while 72% experienced recurrent attacks during their treatment cycles. The mean absolute neutrophil count was 225.5±128.5 x109̸l (range, 10‑497 x109̸l), starting 14.2±16.3 days (range, 2‑100 days) after the onset of chemotherapy and resolving within 11.2±7.3 days, either with (45.1%) or without (54.9%) granulocyte colony‑stimulating factor (G‑CSF). No significant association was observed between any patient characteristics or disease stage and the risk for CIN. However, certain malignancies, such as acute lymphocytic leukemia (ALL), neuroblastoma and Burkitt's lymphoma, and certain regimens, such as induction block for ALL and acute myelocytic leukemia, exerted the most potent myelotoxic effect, with severe and prolonged episodes of neutropenia. G‑CSF significantly shortened the duration of the episodes and enhanced bone marrow recovery. Febrile neutropenia was the leading complication among our cases (73.5%) and was associated with several documented infections, particularly mucositis (54.9%), respiratory (45.1%), gastrointestinal tract (38.9%) and skin (23.9%) infections. A total of 6% of our patients succumbed to infection‑related complications. Neutropenia was responsible for treatment discontinuation (13.3%), dose delay (13.3%) and dose reduction (5.3%) in our patients. The mean cost for each episode in our institution was 9,386.5±6,688.9 Egyptian pounds, which represented a significant burden on health care providers.
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September-2016
Volume 5 Issue 3

Print ISSN: 2049-9450
Online ISSN:2049-9469

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Spandidos Publications style
Badr M, Hassan T, Sakr H, Karam N, Rahman DA, Shahbah D, Zakaria M and Fehr S: Chemotherapy‑induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences. Mol Clin Oncol 5: 300-306, 2016.
APA
Badr, M., Hassan, T., Sakr, H., Karam, N., Rahman, D.A., Shahbah, D. ... Fehr, S. (2016). Chemotherapy‑induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences. Molecular and Clinical Oncology, 5, 300-306. https://doi.org/10.3892/mco.2016.957
MLA
Badr, M., Hassan, T., Sakr, H., Karam, N., Rahman, D. A., Shahbah, D., Zakaria, M., Fehr, S."Chemotherapy‑induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences". Molecular and Clinical Oncology 5.3 (2016): 300-306.
Chicago
Badr, M., Hassan, T., Sakr, H., Karam, N., Rahman, D. A., Shahbah, D., Zakaria, M., Fehr, S."Chemotherapy‑induced neutropenia among pediatric cancer patients in Egypt: Risks and consequences". Molecular and Clinical Oncology 5, no. 3 (2016): 300-306. https://doi.org/10.3892/mco.2016.957