Febrile neutropenia in children and adolescents with acute myeloid leukemia during induction therapy.

BACKGROUND

Febrile neutropenia (FN) is a serious and potentially life-threatening complication in children with acute myeloid leukemia (AML), particularly during induction chemotherapy. However, data from low- and middle-income countries remain limited.

METHODS

We conducted a retrospective study including children and adolescents with newly diagnosed AML who experienced at least one FN episode during induction therapy at Aziza Othmana Hospital, Tunis, Tunisia.

RESULTS

Among 63 patients with AML, 55 (87.3%) experienced 82 FN episodes. No patient received antibacterial or antifungal prophylaxis. Clinically documented infections (CDI) accounted for 53.6% of episodes, fever of unknown origin for 25.7%, and microbiologically documented infections (MDI) for 20.7%. The gastrointestinal tract was the most frequent site of infection (50%), followed by the respiratory tract (31.8%). Blood cultures yielded predominantly Gram-negative bacilli and Gram-positive cocci in similar proportions. Multidrug-resistant Gram-negative bacteria were identified in five episodes. Clinical outcomes were favorable in 77 episodes (94%), with a median time to defervescence of four days. Five patients died, resulting in a FN-related mortality rate of 9%. Intensive care unit (ICU) admission and presence of sepsis/septic shock were associated with mortality in univariate analysis.

CONCLUSION

FN remains a major cause of morbidity and mortality during AML induction therapy. Early recognition, prompt antimicrobial treatment, and improved access to microbiological diagnostics may improve outcomes in resource-limited settings.