Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Design
2.2. Neoadjuvant Chemotherapy Regimens
2.3. Standard of Care
2.4. Definitions
2.5. Statistical Analysis
3. Results
3.1. Patient Demographics
3.2. Overall Infectious and Non-Infectious Patient Morbidity
3.3. Febrile Neutropenia and Infections during Chemotherapy
3.4. Hospitalization, ICU Admission and Mucositis
3.5. Factors Associated with FN and MDI
3.6. Overall and Event-Free Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | No. (%) or Median (Range) | |||
---|---|---|---|---|
All | EWING 2008 | CWS SoTiSaR | EURAMOS | |
(n = 170) | (n = 58) | (n = 50) | (n = 62) | |
Age | 13 (0–21) | 14 (0–21) | 9.5 (0–18) | 13.5 (2–18) |
0–4 years | 18 (10.6) | 3 (5.2) | 13 (26.0) | 2 (3.2) |
5–9 years | 27 (15.9) | 9 (15.5) | 12 (24.0) | 6 (9.7) |
10–14 years | 72 (42.4) | 24 (41.4) | 15 (30.0) | 33 (53.2) |
15–19 years | 51 (30.0) | 20 (34.5) | 10 (20.0) | 21 (33.9) |
≥20 years | 2 (1.2) | 2 (3.4) | 0 | 0 |
Sex | ||||
male | 96 (56.5) | 36 (62.1) | 22 (44.0) | 38 (61.3) |
female | 74 (43.5) | 22 (37.9) | 28 (56.0) | 24 (38.7) |
BMI at baseline | 18.9 (10.0–38.1) | 20.0 (10.0–34.3) | 17.6 (11.4–27.0) | 19.1 (12.9–38.1) |
BMI < P10 | 26 (15.3) | 8 (13.8) | 9 (18.0) | 9 (14.5) |
BMI P10–P90 | 126 (74.1) | 41 (70.7) | 38 (76.0) | 47 (75.8) |
BMI > P90 | 18 (10.6) | 9 (15.5) | 3 (6.0) | 6 (9.7) |
Underlying condition | ||||
Ewing sarcoma | 53 (31.2) | 53 (91.4) | 0 | 0 |
osteosarcoma | 62 (36.5) | 0 | 0 | 62 (100) |
rhabdomyosarcoma | 31 (18.2) | 0 | 31 (62.0) | 0 |
NOS | 5 (2.9) | 2 (3.4) | 3 (6.0) | 0 |
Ewing-like-sarcoma | 2 (1.2) | 2 (3.4) | 0 | 0 |
synovial sarcoma | 8 (4.7) | 0 | 8 (16.0) | 0 |
PNET | 1 (0.6) | 1 (1.7) | 0 | 0 |
infantile fibrosarcoma | 1 (0.6) | 0 | 1 (2.0) | 0 |
liposarcoma | 1 (0.6) | 0 | 1 (2.0) | 0 |
DSRCT | 1 (0.6) | 0 | 1 (2.0) | 0 |
MPNST | 2 (1.2) | 0 | 2 (4.0) | 0 |
pleuropulmonary blastoma | 2 (1.2) | 0 | 2 (4.0) | 0 |
neuroblastoma 1 | 1 (0.6) | 0 | 1 (2.0) | 0 |
Tumor localization | ||||
extremities | 106 (62.4) | 30 (51.7) | 17 (34.0) | 59 (95.2) |
trunk | 46 (27.1) | 24 (41.4) | 20 (40.0) | 2 (3.2) |
other | 18 (10.6) | 4 (6.9) | 13 (26.0) | 1 (1.6) |
Any metastases at diagnosis | 63 (37.3) | 29 (50.0) | 15 (30.0) | 19 (31.1) |
distant metastases | 56 (33.1) | 26 (44.8) | 11 (22.0) | 19 (31.1) |
lung | 30 (53.6) | 12 (46.2) | 3 (27.3) | 15 (78.9) |
bone | 10 (17.9) | 6 (23.1) | 2 (18.2) | 2 (10.5) |
lymph nodes | 2 (3.6) | 0 | 2 (18.2) | 0 |
other | 2 (3.6) | 1 (3.8) | 1 (9.1) | 0 |
multiple (≥2 organs) | 12 (21.4) | 7 (26.9) | 3 (27.3) | 2 (10.5) |
regional lymph node infiltration | 23 (13.5) | 14 (24.1) | 8 (16.0) | 1 (1.6) |
skip lesions | 9 (5.3) | 6 (10.5) | 0 | 3 (4.8) |
Number of chemotherapy courses 2 | 948 | 341 | 239 | 368 |
per patient | 6 (2–8) | 6 (3–7) | 5 (2–8) | 6 (3–8) |
G-CSF administration 3 | 67 (39.4) | 57 (98.3) | 9 (18.0) | 1 (1.6) |
Characteristic | No. (%) or Median (Range) | chi 2 Test | |||
---|---|---|---|---|---|
All | EWING 2008 | CWS SoTiSaR | EURAMOS | ||
(n = 170) | (n = 58) | (n = 50) | (n = 62) | p-Value | |
Febrile neutropenia | |||||
≥1 episode of FN | 100 (58.8) | 49 (84.5) | 32 (64.0) | 19 (30.6) | <0.001 |
≥2 episodes of FN | 63 (37.1) | 40 (69.0) | 17 (34.0) | 6 (9.7) | <0.001 |
Microbiologically documented infection | |||||
≥1 episode of MDI | 35 (20.6) | 17 (29.3) | 10 (20.0) | 8 (12.9) | 0.084 |
≥2 episodes of MDI | 6 (3.5) | 4 (6.9) | 1 (2.0) | 1 (1.6) | 0.230 |
Clinically documented infection | |||||
≥1 episode of CDI | 18 (10.6) | 8 (13.8) | 5 (10.0) | 5 (8,1) | 0.587 |
≥2 episodes of CDI | 1 (0.6) | 1 (1.7) | 0 | 0 | 0.379 |
ICU admission | 5 (2.9) | 2 (3.4) | 3 (6.0) | 0 | 0.168 |
Weight loss during chemotherapy in % | 7.0 (0–31.2) | 7.2 (0–25.1) | 4.1 (0–17.9) | 8.4 (0–31.2) | |
Overall treatment delay in days | 7.0 (0–61) | 8.5 (0–61) | 4.0 (0–23) | 9.0 (0–48) | |
Survival through local therapy | 165 (100) 1,2,3 | 57 (100) 1 | 49 (100) 2 | 59 (100) 3 |
Characteristic | No. (%) of Courses or Median (Range) | chi 2 Test | |||
---|---|---|---|---|---|
All | EWING 2008 | CWS SoTiSaR | EURAMOS | p-Value | |
(n = 948) | (n = 341) | (n = 239) | (n = 368) | ||
Neutropenia | 519 (54.9) | 321 (94.1) | 157 (65.7) | 41 (11.2) | <0.001 |
Febrile neutropenia | 272 (28.7) | 179 (52.5) | 67 (28.0) | 26 (7.1) | <0.001 |
FUO | 231 (24.4) | 152 (44.6) | 55 (23.0) | 24 (6.5) | <0.001 |
Documented infections 1 | 64 (6.0 1) | 32 (8.5 1) | 18 (6.3 1) | 14 (3.5 1) | 0.020 |
MDIs 1 | 45 (4.4 1) | 23 (6.5 1) | 13 (4.6 1) | 9 (2.4 1) | 0.035 |
CDIs | 19 (2.0) | 9 (2.6) | 5 (2.1) | 5 (1.4) | 0.475 |
Unscheduled hospitalization | 354 (37.4) | 192 (56.3) | 79 (33.2) | 83 (22.6) | <0.001 |
duration in days | 7.0 (1–23) | 7.0 (2–21) | 5.0 (2–21) | 7.0 (1–23) | |
ICU admission | 5 (0.5) | 2 (0.6) | 3 (1.3) | 0 | 0.112 |
duration in days | 9.0 (2–21) | 5.0 (2–8) | 11.0 (8–21) | ||
infectious cause | 2 | 2 | 0 | ||
Mucositis | <0.001 | ||||
no mucositis | 662 (69.8) | 109 (32.0) | 225 (94.1) | 328 (89.1) | |
CTC grade 1–2 | 149 (15.7) | 138 (40.5) | 3 (1.3) | 8 (2.2) | |
CTC grade 3–4 | 137 (14.5) | 94 (27.6) | 11 (4.6) | 32 (8.7) |
Infection | MDI (No.) | CDI (No.) | ||
---|---|---|---|---|
Bacterial | Fungal | Viral | ||
Gram+/Gram− | ||||
Blood stream infection | 17/6 1 | - | - | - |
Systemic infection | 0/0 | 1 6 | 1 7 | - |
Organ infection | - | - | - | - |
Central nervous system | 1/0 2 | - | - | - |
Oropharynx | - | - | 3 8 | 2 10 |
Upper respiratory tract | - | - | 7 9 | 5 11 |
Lung | - | - | - | 2 12 |
Abdomen and gastrointestinal tract | 7/0 3 | - | - | 4 13 |
Urogenital tract | 2/2 4 | - | - | 2 14 |
Bone and soft tissues | 1/3 5 | - | - | 4 15 |
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Willmer, D.; Zöllner, S.K.; Schaumburg, F.; Jürgens, H.; Lehrnbecher, T.; Groll, A.H. Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma. Cancers 2021, 13, 1990. https://doi.org/10.3390/cancers13091990
Willmer D, Zöllner SK, Schaumburg F, Jürgens H, Lehrnbecher T, Groll AH. Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma. Cancers. 2021; 13(9):1990. https://doi.org/10.3390/cancers13091990
Chicago/Turabian StyleWillmer, Denise, Stefan K. Zöllner, Frieder Schaumburg, Heribert Jürgens, Thomas Lehrnbecher, and Andreas H. Groll. 2021. "Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma" Cancers 13, no. 9: 1990. https://doi.org/10.3390/cancers13091990