Neutropenia, fever, and infection in children with acute lymphocytic leukemia
J. A. Wolk, M. J. Stuart, J. A. Stockman 3rd and F. A. Oski
In an attempt to determine the relationship between neutropenia (absolute
granulocyte count less than 1,000/cu mm), infection, and disease status, 20
patients with acute lymphoblastic leukemia were observed for a total of 34
patient-years. Febrile episodes occurred with much greater frequency in
patients during the course of treatment induction (0.9/mo), or while in
relapse (2.46/mo) than while in remission (0.19/mo). A cause for fever was
identified much more frequently in patients in remission, both when
neutropenic and nonneutropenic. When absolute granulocyte counts fell below
200/cu mm, a cause for fever was generally identified regardless of disease
status. We propose that the majority of febrile episodes in patients at the
time of induction of treatment or in relapse with neutrophil counts of more
than 200/cu mm are caused by the disease process rather than secondary to a
diagnosable infection.
