Ethem ERGİNÖZ, Gülen TÜYSÜZ, İnci YILDIZ, Leman YANTRİ, Nigar ÇELİK, Hilmi APAK, Alp ÖZKAN, Nihal ÖZDEMİR, Tiraje CELKAN

Akut lenfoblastik lösemili çocuklarda ateşli nötropeni: tek merkez sonuçları

Amaç: Lösemili çocuklarda uygulanan yoğun kemoterapinin, yaşamı tehdit eden önemli bir komplikasyonu ateşli nötropenidir. Çalışmanın amacı akut lenfoblastik lösemi tanısıyla tedavi alan çocuklarda, ateşli nötropeni ataklarının klinik özelliklerinin ve sonuçlarının değerlendirilmesidir.Gereç ve Yöntemler: Çalışmaya merkezimizde Ocak 1995-Aralık 2010 yılları arasında akut lenfoblastik lösemi nedeniyle kemoterapi uygulanan 96 çocuk alındı. Hasta dosyalarından geriye dönük olarak demografik bilgiler, tedavi özellikleri, hastalık yineleme ve ateşli nötropeni sıklıkları, risk etmenleri, kültür sonuçları ve seyir değerlendirildi.Bulgular: Çalışmaya alınan hastalarda birincil ve yineleyen hastalık tedavileri sırasında görülen toplam 299 ateşli nötropeni atağı değerlendirildi. Ateşli nötropeni sıklığı yıllara göre değerlendirildiğinde; 2000 yılından sonra tedavi edilen hastalarda, 2000 yılından önce tedavi edilenlerden daha fazla ateşli nötropeni atağı olduğu görüldü. Tanı sonrası birincil tedavi ve yineleyen hastalık tedavisi sırasında geçirilen ateşli nötropeni atak sıklığı karşılaştırıldığında, yineleyen hastalık tedavisinde daha çok ateşli nötropeni atağı olduğu görüldü. Tüm ateşli nötropeni ataklarının %59'u nedeni açıklanamayan ateşti. Tedavileri boyunca 75 hastada ateşli nötropeni sırasında 80 üreme oldu; %86'sı bakteriyel (%50 gram pozitif, %50 gram negatif ), %8'i viral enfeksiyon ve %6'sı mantar enfeksiyonuydu. Koagülaz negatif stafilokok (n=17) en sık gram pozitif etkendi; E. Coli (n=17) en sık üretilen gram negatif bakteriydi. Çıkarımlar: Bu çalışmada yıllar içinde ateşli nötropeni sıklığında bir artış olduğu saptandı. Bu artış 2004 yılından sonra daha belirgin idi. Tedavi yoğunluklarında yapılan artışlar sağkalımı düzeltirken beraberinde enfeksiyon sıklığını arttırmaktadır. Hematoloji Onkoloji birimlerinin kendi ateşli nötropeni sonuçlarını yıllar içinde değerlendirmesi, erken ve başarılı tedavide yol gösterici olacaktır.

Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience

Aim: An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. Material and Methods: Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related with demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients' files. Results: A total of two hundred ninety nine febrile neutropenia attacks observed in the patients included in the study during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after the year of 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before the year of 2000. When the incidences of febrile neutropenia during initial treatment after the diagnosis and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganism grew in culture during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. Conclusions: In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving survival. Evaluation of febrile neutropenia results by hematology-oncology units in years will be directive in early and successful treatment.

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