Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Fever in children with chemotherapy-induced neutropenia

Nabil M Ahmed, MD, MPH
Patricia M Flynn, MD
Section Editors
Morven S Edwards, MD
David G Poplack, MD
Deputy Editor
Mary M Torchia, MD


Infection is a major cause of morbidity and mortality in cancer patients [1]. Fever may be the first manifestation of a life-threatening infection, particularly during periods of neutropenia. Febrile episodes occur in approximately one-third of neutropenic episodes in children with chemotherapy-induced neutropenia or after hematopoietic cell transplantation [2]. The approximate rate of occurrence is 0.76 episodes per every 30 days of neutropenia.

The demonstration of markedly reduced infection-related morbidity and mortality with the empiric use of broad-spectrum antibiotics during periods of febrile neutropenia was a major advance in the field of oncology in the 1970s [3,4]. Subsequent studies identified factors associated with a higher risk of bacterial infection and facilitated a more tailored approach to empiric therapy.

Because of important differences between oncology and hematology patients with neutropenia, fever in the pediatric cancer patient during periods of therapy-induced neutropenia are reviewed here. The types of infections and management of fever in the child with other forms of neutropenia are discussed separately. (See "Risk of infection in children with fever and non-chemotherapy-induced neutropenia" and "Evaluation and management of fever in children with non-chemotherapy-induced neutropenia".)

Fever in adult cancer patients with neutropenia is discussed separately. (See "Overview of neutropenic fever syndromes" and "Risk assessment of adults with chemotherapy-induced neutropenia" and "Diagnostic approach to the adult cancer patient with neutropenic fever" and "Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients)" and "Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications".)


Neutropenia — Neutropenia is defined as an absolute neutrophil count (ANC) <1500 cells/microL. The ANC is calculated using the following formula:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 03, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Auletta JJ, O'Riordan MA, Nieder ML. Infections in children with cancer: a continued need for the comprehensive physical examination. J Pediatr Hematol Oncol 1999; 21:501.
  2. Castagnola E, Fontana V, Caviglia I, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis 2007; 45:1296.
  3. Bodey GP, Whitecar JP Jr, Middleman E, Rodriguez V. Carbenicillin therapy for pseudomonas infections. JAMA 1971; 218:62.
  4. Schimpff S, Satterlee W, Young VM, Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971; 284:1061.
  5. Koh AY, Pizzo PA. Infectious complications in pediatric cancer patients. In: Principles and Practice of Pediatric Oncology, 6th ed, Pizzo PA, Poplack DG (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.1190.
  6. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52:e56.
  7. National Institute for Health and Care Excellence. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients. 2012. http://publications.nice.org.uk/neutropenic-sepsis-prevention-and-management-of-neutropenic-sepsis-in-cancer-patients-cg151 (Accessed on June 19, 2013).
  8. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328.
  9. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982; 72:101.
  10. Lehrnbecher T, Foster C, Vázquez N, et al. Therapy-induced alterations in host defense in children receiving therapy for cancer. J Pediatr Hematol Oncol 1997; 19:399.
  11. Wolff LJ, Ablin AR, Altman AJ, Johnson FL. The management of fever. In: Supportive care of children with cancer: Current therapy and guidelines from the Children's Cancer Group, Ablin AR (Ed), Johns Hopkins University Press, Baltimore 1997. p.23.
  12. Klaassen RJ, Goodman TR, Pham B, Doyle JJ. "Low-risk" prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol 2000; 18:1012.
  13. Phillips RS, Lehrnbecher T, Alexander S, Sung L. Updated systematic review and meta-analysis of the performance of risk prediction rules in children and young people with febrile neutropenia. PLoS One 2012; 7:e38300.
  14. Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol 2017; 35:2082.
  15. Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000; 18:3038.
  16. Lucas KG, Brown AE, Armstrong D, et al. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer 1996; 77:791.
  17. Rackoff WR, Gonin R, Robinson C, et al. Predicting the risk of bacteremia in childen with fever and neutropenia. J Clin Oncol 1996; 14:919.
  18. Hakim H, Flynn PM, Knapp KM, et al. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2009; 31:623.
  19. Agyeman P, Kontny U, Nadal D, et al. A prospective multicenter study of microbiologically defined infections in pediatric cancer patients with fever and neutropenia: Swiss Pediatric Oncology Group 2003 fever and neutropenia study. Pediatr Infect Dis J 2014; 33:e219.
  20. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147.
  21. Ahmed N, El-Mahallawy HA, Ahmed IA, et al. Early hospital discharge versus continued hospitalization in febrile pediatric cancer patients with prolonged neutropenia: A randomized, prospective study. Pediatr Blood Cancer 2007; 49:786.
  22. Roguin A, Kasis I, Ben-Arush MW, et al. Fever and neutropenia in children with malignant disease. Pediatr Hematol Oncol 1996; 13:503.
  23. Agyeman P, Aebi C, Hirt A, et al. Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Infect Dis J 2011; 30:e114.
  24. Doganis D, Asmar B, Yankelevich M, et al. Predictive factors for blood stream infections in children with cancer. Pediatr Hematol Oncol 2013; 30:403.
  25. Aquino VM, Pappo A, Buchanan GR, et al. The changing epidemiology of bacteremia in neutropenic children with cancer. Pediatr Infect Dis J 1995; 14:140.
  26. Walsh TJ, Pizzo PA. Nosocomial fungal infections: a classification for hospital-acquired fungal infections and mycoses arising from endogenous flora or reactivation. Annu Rev Microbiol 1988; 42:517.
  27. Pizzo PA, Walsh TJ. Fungal infections in the pediatric cancer patient. Semin Oncol 1990; 17:6.
  28. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years' experience at a cancer center and implications for management. Blood 1997; 90:999.
  29. Mor M, Gilad G, Kornreich L, et al. Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer 2011; 56:1092.
  30. Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J 2007; 26:700.
  31. Katsimpardi K, Papadakis V, Pangalis A, et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment. Support Care Cancer 2006; 14:277.
  32. Lindblom A, Bhadri V, Söderhäll S, et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol 2010; 47:234.
  33. Torres JP, Labraña Y, Ibañez C, et al. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J 2012; 31:889.
  34. Suryadevara M, Tabarani CM, Bartholoma N, et al. Nasopharyngeal detection of respiratory viruses in febrile neutropenic children. Clin Pediatr (Phila) 2012; 51:1164.
  35. Torres JP, De la Maza V, Kors L, et al. Respiratory Viral Infections and Coinfections in Children With Cancer, Fever and Neutropenia: Clinical Outcome of Infections Caused by Different Respiratory Viruses. Pediatr Infect Dis J 2016; 35:949.
  36. Orgel E, Ji L, Pastor W, Schore RJ. Infectious morbidity by catheter type in neutropenic children with cancer. Pediatr Infect Dis J 2014; 33:263.
  37. Doganis D, Asmar B, Yankelevich M, et al. How many sources should be cultured for the diagnosis of a blood stream infection in children with cancer? Pediatr Hematol Oncol 2013; 30:416.
  38. Adamkiewicz TV, Lorenzana A, Doyle J, Richardson S. Peripheral vs. central blood cultures in patients admitted to a pediatric oncology ward. Pediatr Infect Dis J 1999; 18:556.
  39. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1.
  40. Alexander SW, Wade KC, Hibberd PL, Parsons SK. Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2002; 24:38.
  41. Franklin JA, Gaur AH, Shenep JL, et al. In situ diagnosis of central venous catheter-related bloodstream infection without peripheral blood culture. Pediatr Infect Dis J 2004; 23:614.
  42. Robinson JL. Sensitivity of a blood culture drawn through a single lumen of a multilumen, long-term, indwelling, central venous catheter in pediatric oncology patients. J Pediatr Hematol Oncol 2002; 24:72.
  43. Neemann K, Yonts AB, Qiu F, et al. Blood Cultures for Persistent Fever in Neutropenic Pediatric Patients Are of Low Diagnostic Yield. J Pediatric Infect Dis Soc 2016; 5:218.
  44. Sandoval C, Sinaki B, Weiss R, et al. Urinary tract infections in pediatric oncology patients with fever and neutropenia. Pediatr Hematol Oncol 2012; 29:68.
  45. Renoult E, Buteau C, Turgeon N, et al. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer 2004; 43:224.
  46. Korones DN. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer 2004; 43:715.
  47. Perron T, Emara M, Ahmed S. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. BMC Health Serv Res 2014; 14:162.
  48. Fletcher M, Hodgkiss H, Zhang S, et al. Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer 2013; 60:1299.
  49. Salstrom JL, Coughlin RL, Pool K, et al. Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs. Pediatr Blood Cancer 2015; 62:807.
  50. Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother 2014; 58:3799.
  51. Haeusler GM, Mechinaud F, Daley AJ, et al. Antibiotic-resistant Gram-negative bacteremia in pediatric oncology patients--risk factors and outcomes. Pediatr Infect Dis J 2013; 32:723.
  52. Sotiropoulos SV, Jackson MA, Woods GM, et al. Alpha-streptococcal septicemia in leukemic children treated with continuous or large dosage intermittent cytosine arabinoside. Pediatr Infect Dis J 1989; 8:755.
  53. Paganini H, Staffolani V, Zubizarreta P, et al. Viridans streptococci bacteraemia in children with fever and neutropenia: a case-control study of predisposing factors. Eur J Cancer 2003; 39:1284.
  54. De Pauw BE, Deresinski SC, Feld R, et al. Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. The Intercontinental Antimicrobial Study Group. Ann Intern Med 1994; 120:834.
  55. Hathorn JW, Rubin M, Pizzo PA. Empirical antibiotic therapy in the febrile neutropenic cancer patient: clinical efficacy and impact of monotherapy. Antimicrob Agents Chemother 1987; 31:971.
  56. Pizzo PA, Hathorn JW, Hiemenz J, et al. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 1986; 315:552.
  57. Robinson PD, Lehrnbecher T, Phillips R, et al. Strategies for Empiric Management of Pediatric Fever and Neutropenia in Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: A Systematic Review of Randomized Trials. J Clin Oncol 2016; 34:2054.
  58. Paul M, Dickstein Y, Schlesinger A, et al. Beta-lactam versus beta-lactam-aminoglycoside combination therapy in cancer patients with neutropenia. Cochrane Database Syst Rev 2013; :CD003038.
  59. Sano H, Kobayashi R, Suzuki D, et al. A prospective randomized trial comparing piperacillin/tazobactam with meropenem as empirical antibiotic treatment of febrile neutropenic children and adolescents with hematologic and malignant disorders. Pediatr Blood Cancer 2017; 64.
  60. Courter JD, Kuti JL, Girotto JE, Nicolau DP. Optimizing bactericidal exposure for beta-lactams using prolonged and continuous infusions in the pediatric population. Pediatr Blood Cancer 2009; 53:379.
  61. Ramphal R, Bolger M, Oblon DJ, et al. Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime: a randomized prospective study. Antimicrob Agents Chemother 1992; 36:1062.
  62. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis 1991; 163:951.
  63. Feld R. Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer: pros and cons. Clin Infect Dis 1999; 29:503.
  64. Beyar-Katz O, Dickstein Y, Borok S, et al. Empirical antibiotics targeting gram-positive bacteria for the treatment of febrile neutropenic patients with cancer. Cochrane Database Syst Rev 2017; 6:CD003914.
  65. Elting LS, Rubenstein EB, Rolston KV, Bodey GP. Outcomes of bacteremia in patients with cancer and neutropenia: observations from two decades of epidemiological and clinical trials. Clin Infect Dis 1997; 25:247.
  66. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 1995; 23:87.
  67. Tamma PD, Turnbull AE, Harris AD, et al. Less is more: combination antibiotic therapy for the treatment of gram-negative bacteremia in pediatric patients. JAMA Pediatr 2013; 167:903.
  68. Gupta A, Swaroop C, Agarwala S, et al. Randomized controlled trial comparing oral amoxicillin-clavulanate and ofloxacin with intravenous ceftriaxone and amikacin as outpatient therapy in pediatric low-risk febrile neutropenia. J Pediatr Hematol Oncol 2009; 31:635.
  69. Freifeld A, Marchigiani D, Walsh T, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med 1999; 341:305.
  70. Cagol AR, Castro Junior CG, Martins MC, et al. Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy. J Pediatr (Rio J) 2009; 85:531.
  71. Villarroel M, Avilés CL, Silva P, et al. Risk factors associated with invasive fungal disease in children with cancer and febrile neutropenia: a prospective multicenter evaluation. Pediatr Infect Dis J 2010; 29:816.
  72. American Academy of Pediatrics. Immunization in immunocompromised children. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, 2015. p.74.
  73. Castagnola E, Cesaro S, Giacchino M, et al. Fungal infections in children with cancer: a prospective, multicenter surveillance study. Pediatr Infect Dis J 2006; 25:634.
  74. Rosen GP, Nielsen K, Glenn S, et al. Invasive fungal infections in pediatric oncology patients: 11-year experience at a single institution. J Pediatr Hematol Oncol 2005; 27:135.
  75. Zaoutis TE, Heydon K, Chu JH, et al. Epidemiology, outcomes, and costs of invasive aspergillosis in immunocompromised children in the United States, 2000. Pediatrics 2006; 117:e711.
  76. Groll AH, Kurz M, Schneider W, et al. Five-year-survey of invasive aspergillosis in a paediatric cancer centre. Epidemiology, management and long-term survival. Mycoses 1999; 42:431.
  77. Lehrnbecher T, Phillips R, Alexander S, et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 2012; 30:4427.
  78. Lehrnbecher T, Robinson PD, Fisher BT, et al. Galactomannan, β-D-Glucan, and Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis. Clin Infect Dis 2016; 63:1340.
  79. He S, Hang JP, Zhang L, et al. A systematic review and meta-analysis of diagnostic accuracy of serum 1,3-β-D-glucan for invasive fungal infection: Focus on cutoff levels. J Microbiol Immunol Infect 2015; 48:351.
  80. Lamoth F, Cruciani M, Mengoli C, et al. β-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis 2012; 54:633.
  81. Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med 1999; 340:764.
  82. Sandler ES, Mustafa MM, Tkaczewski I, et al. Use of amphotericin B colloidal dispersion in children. J Pediatr Hematol Oncol 2000; 22:242.
  83. Prentice HG, Hann IM, Herbrecht R, et al. A randomized comparison of liposomal versus conventional amphotericin B for the treatment of pyrexia of unknown origin in neutropenic patients. Br J Haematol 1997; 98:711.
  84. White MH, Bowden RA, Sandler ES, et al. Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 1998; 27:296.
  85. Blyth CC, Hale K, Palasanthiran P, et al. Antifungal therapy in infants and children with proven, probable or suspected invasive fungal infections. Cochrane Database Syst Rev 2010; :CD006343.
  86. Maertens JA, Madero L, Reilly AF, et al. A randomized, double-blind, multicenter study of caspofungin versus liposomal amphotericin B for empiric antifungal therapy in pediatric patients with persistent fever and neutropenia. Pediatr Infect Dis J 2010; 29:415.
  87. Jørgensen KJ, Gøtzsche PC, Johansen HK. Voriconazole versus amphotericin B in cancer patients with neutropenia. Cochrane Database Syst Rev 2006; :CD004707.
  88. Pizzo PA, Robichaud KJ, Gill FA, et al. Duration of empiric antibiotic therapy in granulocytopenic patients with cancer. Am J Med 1979; 67:194.
  89. Ammann RA, Bodmer N, Hirt A, et al. Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study. J Clin Oncol 2010; 28:2008.
  90. Aquino VM, Buchanan GR, Tkaczewski I, Mustafa MM. Safety of early hospital discharge of selected febrile children and adolescents with cancer with prolonged neutropenia. Med Pediatr Oncol 1997; 28:191.
  91. Bash RO, Katz JA, Cash JV, Buchanan GR. Safety and cost effectiveness of early hospital discharge of lower risk children with cancer admitted for fever and neutropenia. Cancer 1994; 74:189.
  92. Lehrnbecher T, Stanescu A, Kühl J. Short courses of intravenous empirical antibiotic treatment in selected febrile neutropenic children with cancer. Infection 2002; 30:17.
  93. Clarke V, Dunstan FD, Webb DK. Granulocyte colony-stimulating factor ameliorates toxicity of intensification chemotherapy for acute lymphoblastic leukemia. Med Pediatr Oncol 1999; 32:331.
  94. Michon JM, Hartmann O, Bouffet E, et al. An open-label, multicentre, randomised phase 2 study of recombinant human granulocyte colony-stimulating factor (filgrastim) as an adjunct to combination chemotherapy in paediatric patients with metastatic neuroblastoma. Eur J Cancer 1998; 34:1063.
  95. Pui CH, Boyett JM, Hughes WT, et al. Human granulocyte colony-stimulating factor after induction chemotherapy in children with acute lymphoblastic leukemia. N Engl J Med 1997; 336:1781.
  96. Riikonen P, Rahiala J, Salonvaara M, Perkkiö M. Prophylactic administration of granulocyte colony-stimulating factor (filgrastim) after conventional chemotherapy in children with cancer. Stem Cells 1995; 13:289.
  97. Welte K, Reiter A, Mempel K, et al. A randomized phase-III study of the efficacy of granulocyte colony-stimulating factor in children with high-risk acute lymphoblastic leukemia. Berlin-Frankfurt-Münster Study Group. Blood 1996; 87:3143.
  98. Sung L, Nathan PC, Lange B, et al. Prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor decrease febrile neutropenia after chemotherapy in children with cancer: a meta-analysis of randomized controlled trials. J Clin Oncol 2004; 22:3350.
  99. Mitchell PL, Morland B, Stevens MC, et al. Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients. J Clin Oncol 1997; 15:1163.
  100. Ozkaynak MF, Krailo M, Chen Z, Feusner J. Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia: a report from the Children's Oncology Group. Pediatr Blood Cancer 2005; 45:274.
  101. Riikonen P, Saarinen UM, Mäkipernaa A, et al. Recombinant human granulocyte-macrophage colony-stimulating factor in the treatment of febrile neutropenia: a double blind placebo-controlled study in children. Pediatr Infect Dis J 1994; 13:197.
  102. Lehrnbecher T, Welte K. Haematopoietic growth factors in children with neutropenia. Br J Haematol 2002; 116:28.
  103. Schaison G, Eden OB, Henze G, et al. Recommendations on the use of colony-stimulating factors in children: conclusions of a European panel. Eur J Pediatr 1998; 157:955.
  104. Clark OA, Lyman G, Castro AA, et al. Colony stimulating factors for chemotherapy induced febrile neutropenia. Cochrane Database Syst Rev 2003; :CD003039.
  105. Mustafa MM, Aquino VM, Pappo A, et al. A pilot study of outpatient management of febrile neutropenic children with cancer at low risk of bacteremia. J Pediatr 1996; 128:847.
  106. Mullen CA, Petropoulos D, Roberts WM, et al. Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients. Cancer 1999; 86:126.
  107. Shenep JL, Flynn PM, Baker DK, et al. Oral cefixime is similar to continued intravenous antibiotics in the empirical treatment of febrile neutropenic children with cancer. Clin Infect Dis 2001; 32:36.
  108. Paganini H, Gómez S, Ruvinsky S, et al. Outpatient, sequential, parenteral-oral antibiotic therapy for lower risk febrile neutropenia in children with malignant disease: a single-center, randomized, controlled trial in Argentina. Cancer 2003; 97:1775.