Aims Children with haematological cancers and those on steroid treatment or other highly myelosuppressive therapies, are at high risk of bone marrow failure and multiple episodes of neutropenia over the course of their treatment. These patients are therefore at high risk of invasive fungal disease (IFD). In contrast, other childhood malignancy, particularly paediatric solid tumours, uncommonly presents with bone marrow failure, infrequently suffer neutropenic episodes and can be classed as low risk for IFD. The aim of this project was to assess the value of CT chest imaging in febrile neutropenic patients at low risk of IFD, focussing particularly on solid tumour patients.
Methods A retrospective study looking at admissions to the Paediatric Haematology and Oncology Ward between 1st January 2013 and 9th May 2014 who had either developed a prolonged neutropenic fever whilst as an in-patient or been transferred from a local hospital for appropriate management of neutropenic fever. Our working definition of prolonged neutropenic fever was a single fever >38°C and neutrophils <0.5 which persists for ≥48 hrs after the initial temperature spike. CT reports and paper notes were used to determine the patient’s condition and subsequent management before and after the scan.
Results 6 CT chest scans were performed on patients with non-haematological cancers and 100% (6/6) showed no evidence of fungal disease. 16 scans were performed on patients with haematological cancers with only 6% (1/16) showing evidence of fungal infection. In addition, when the total duration of fever < 5 days, CT yielded no evidence of fungal infection, independent of malignancy type (n = 7).
Conclusion CT investigation for IFD in febrile neutropenic paediatric solid tumour patients has limited value in the absence of other risk factors. The rationale behind the use of CT in patients at low risk of IFD must be measured against the harm of radiation exposure and financial cost. We propose a management pathway of prolonged neutropenic fever with an emphasis on risk stratification to avoid unnecessary CT usage.
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