RISK STRATIFICATION OF FEBRILE NEUTROPENIA IN CHILDHOOD
Optimizing risk predictive strategies in febrile neutropenic episodes in children and young people with malignant disease
This project will develop a method of accurately assessing the risk of harm faced by children and young adult patients when they present with febrile neutropenia, a complication of treatment for cancer. For a low-risk group, this may allow the reduction of intensity or duration of the aggressive in-patient antibiotic treatment that is currently used, or intensification of therapy for the high risk group. The project will use individual patient data (IPD) pooled analysis, where the data from previously conducted studies are brought together and analysed to come to a more precise conclusion than any individual study could.
The project will form an international collaboration to collect the data, which will include researchers, doctors and parents. The analysis will try to find out if there are particular factors that would help predict which children have the best outcomes. It will start by looking at the simplest information (such as the age of the child, or their diagnosis) and build in more complex data (such as specialized blood test results) to see if these make the prediction more accurate. The results of this analysis will be tested, and the potential economic effects estimated.
The methods used in performing IPD analysis will also be investigated, advancing our understanding of how best to conduct such studies.
Collaborators in the UK, USA, Switzerland, Germany, Italy, India and Columbia have already agreed to take part, and it is hoped this will become a truly global study to improve patient care.
If you are a parent or patient who wants to learn more, or become involved with the project, please read here.
If you are a clinician who would like to become involved with the project, please read here.Conducted by: Bob Phillips1 , Lesley Stewart1 (Supervisor), Ros Wade1 with Alex J Sutton2
1. Centre for Reviews and Dissemination; 2. Department of Health Sciences, University of Leicester
Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Onc 2012;30(35):4427-38
Phillips R, Lehrnbecher T, Alexander S, Sung L. Updated systematic review and meta-analysis of the performance of risk prediction rules in children and young people with febrile neutropenia. PLoS ONE 2012;7(5):e38300 doi:10.1371/journal.pone.0038300
Phillips B, Sutton A, Riley R, Chisholm J, Picton S, Stewart L. Predicting infectious complications in neutropenic children and young people with cancer (IPD Protocol). Syst Rev 2012; 1:8
Phillips R, Wade R, Lehrnbecher T, Stewart L, Sutton A. The value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer: a systematic review and meta-analysis. BMC Med 2012; 10:6: doi:10.1186/1741-7015-10-6
Phillips B, Wade R, Westwood M, Riley R, Sutton AJ. Systematic review and meta-analysis of the value of clinical features to exclude radiographic pneumonia in febrile neutropenic episodes in children and young people. J Paediatr Child Health 2012; 48(8):641-8
Phillips B, Wade R, Stewart L, Sutton A. Systematic review and meta-analysis of the discriminatory performance of risk prediction rules in febrile neutropenic episodes in children and young people. Eur J Cancer. 2010;46(16):2950-64
Sung L, Manji A, Beyene J, Dupuis L, Alexander S, Phillips R, Lehrnbecher T. Fluoroquinolones in pediatric fever and neutropenia – a systematic review of prospective trials. Pediatr Infect Dis J 2011; [Epub ahead of print]Sung L, Phillips R, Lehrnbecher T. Time for paediatric febrile neutropenia guidelines - children are not little adults. Eur J Cancer 2011;47(6):811-3
Commissioned by the Medical Research Council
Page last updated: 12 December 2012