Predictors and Management of Neutropenia Among Paediatric Patients With Haematological Malignancies at Kenyatta National Hospital

Abstract

Background: Neutropenia is a common complication of chemotherapy treatment in patients with malignancies which requires adequate prevention, urgent diagnosis, and appropriate intervention. It is associated with significant morbidity, mortality, and increased healthcare expenditure. There is scanty literature about the burden as well as predictors of neutropenia among paediatric patients with haematological malignancies. Objective: To evaluate the predictors and management of neutropenia among paediatric patients with haematological malignancies at Kenyatta National Hospital. Methodology: A cross-sectional study was conducted on paediatric cancer patients aged between 0-15 years who were attended at Kenyatta National Hospital between January 2019 and June 2022. 143 participants were selected using simple random sampling. Data was collected with a pretested well-structured abstraction tool and stored in a password protected Microsoft Excel Spreadsheet version 2010. It was then be analysed using STATA version 15.1. Chi square test was used to determine presence of significant association between neutropenia and the predictors. Binary and multivariate logistic regression was conducted to deduce any association between presence of neutropenia and the independent variables. The p-value was set at 0.05. Results: A total of 143 haematological cancer patients at Kenyatta National Hospital were evaluated. From bivariate analysis, neutropenia was associated with: ALL, HL, the L2 morphological classification of ALL, induction, consolidation and maintenance treatment phases, heart failure and thrombocytopenia comorbidities as well as use of the combined regimen of 6-mercaptopurine, methotrexate, vincristine, doxorubicin, and cyclophosphamide. Independent predictors of neutropenia were the induction and consolidation phases of treatment. Of the 111 (77.6%) patients who had neutropenia, 17 (15.6%) developed fever. The neutropenia took more than 7 days to resolve in 71 (63.4%) patients. Conclusion: Induction and consolidation phases of treatment were significantly associated with chemotherapy induced neutropenia. The use of GCSF, combination of antibiotics or chemotherapy deferment were employed in the management of febrile neutropenia. Recommendation: Prospective studies should be conducted to unravel other determinants of neutropenia among paediatric haematological cancer patient