Optimizing risk predictive strategies in febrile neutropenic episodes in children and young people undergoing treatment for malignant disease
Children and young people with cancer are treated with drugs which successfully cure their cancer in about four out of every five treated, but also suppress their immune system making them open to life-threatening infections. This situation is known as ‘febrile neutropenia’ (FN), and is usually treated with a blanket approach of admission to hospital and delivery of intravenous antibiotics. In the past, many groups have attempted to devise simple systems to work out which children are least likely to develop severe infections and then allow these children to leave hospital more quickly or be treated less aggressively.
The PICNICC Collaboration was formed to evaluate the existing research, and to collect and quantitatively synthesise this to develop a new risk prediction model. This was accomplished by the groups sharing individual participant data (IPD) from their original studies. The multivariable predictive model was then tested, alongside others from an Australian group, and developed a new simple rule that altered how we managed patients in the COVID19 pandemic and beyond.
The research group has also developed the methods of undertaking such studies, including advice on what aspects to include and ways of conducting the analyses, and have run international symposia.
We have evaluated the benefits of additional blood tests at Leeds Children's Hospital. One study used a two-minute YouTube video to assist explaining the study to children (and their parents).
Using this information, we undertook a pilot study to see if parents, children and hospital staff would be willing to undertake a large trial to see if this biomarker based approach was feasible. This mini-documentary explains the results of both these studies.
We are actively developing the large trial now, along with developing other approaches to managing infection (including fungal infections), and understanding how to help clinical teams advance their clinical service by using risk stratification approaches.
This programme of research has both immediate and longer term possibilities to improve the management of paediatric FN across the world by reducing unnecessary antibiotic usage and increasing intensity of support for those who are likely to become the most seriously unwell.