A prospective survey of febrile events in hematological malignancies

Abstract

The Hema e-Chart prospectively collected data on febrile events (FEs) in hematological malignancy patients (HMs). The aim of the study was to assess the number, causes and outcome of HM-related FEs. Data were collected in a computerized registry that systematically approached the study and the evolution of FEs developing in a cohort of adult HMs who were admitted to 19 hematology departments in Italy from March 2007 to December 2008. A total of 869 FEs in 3,197 patients with newly diagnosed HMs were recorded. Fever of unidentified origin (FUO) was observed in 386 cases (44.4%). The other causes of FE were identified as noninfectious in 48 cases (5.5%) and infectious in 435 cases (50.1%). Bacteria were the most common cause of infectious FEs (301 cases), followed by fungi (95 cases), and viruses (7 cases). Mixed agents were isolated in 32 episodes. The attributable mortality rate was 6.7% (58 FEs). No deaths were observed in viral infection or in the noninfectious groups, while 25 deaths were due to FUO, 16 to bacterial infections, 14 to fungal infections, and three to mixed infections. The Hema e-Chart provided a complete system for the epidemiological study of infectious complications in HMs.

Neoplastic fever in patients with bone and soft tissue sarcoma

“…Naproxen was orally administered at a dose of 300-600 mg per day. Prior to the administration of naproxen, the white blood cell count ranged from 3,870 to 11,120/mm 3 (mean, 8,131/mm 3 ) and the C-reactive protein (CRP) levels ranged from 5.52 to 24.84 mg/dl (mean, 13.4 mg/dl). The serum interleukin-6 (IL-6) level was measured and found to be elevated in 5 of the 11 patients Prior to naproxen 3 days after naproxen Duration of (normal, <4.0 pg/ml; Table I).…”

“…The development of fever is a common complication in the clinical course of cancer (1)(2)(3)(4). It is crucial to determine the origin of fever, as patients are managed differently depending on the cause.…”

“…It is crucial to determine the origin of fever, as patients are managed differently depending on the cause. Neutropenic fever is a common occurrence in patients with neutropenia after intensive chemotherapy (1)(2)(3). Neutropenic fever reportedly occurs in 37% of patients with osteosarcoma (5), 17-26% of patients with Ewing's sarcoma (6) and 8-54 of those with soft tissue sarcoma (7)(8)(9).…”

“…Furthermore, patients with bone and soft tissue sarcomas are at risk of surgical site infection, which was reported to occur in 6-15% of those patients who undergo surgery (10)(11)(12). Even in the absence of surgical site infection and neutropenia, febrile complications often develop (1)(2)(3)(4)13,14). Fever may be caused by diagnostic and/or therapeutic procedures, including medications, transfusions, surgical procedures, hematoma and thrombosis (1)(2)(3)(4)13,14).…”

“…Even in the absence of surgical site infection and neutropenia, febrile complications often develop (1)(2)(3)(4)13,14). Fever may be caused by diagnostic and/or therapeutic procedures, including medications, transfusions, surgical procedures, hematoma and thrombosis (1)(2)(3)(4)13,14). If all the potential causes of fever are excluded, the possibility of neoplastic fever should be considered (13,15,16).…”