Predicting the risk of severe infection in children with chemotherapy-induced febrile neutropenia

Purpose of review Chemotherapy-induced febrile neutropenia is a frequent event in children with cancer with possible severe complications. However, increasing evidence indicates that early discharge or outpatient therapy can safely be proposed for children with low-risk febrile neutropenia. Clinical decision rules (CDRs) have been proposed to help predict the risk of severe infection in children with chemotherapy-induced febrile neutropenia, but none has been fully validated. Recent findings The aim of CDRs for children with febrile neutropenia would be to identify patients at low risk of severe infection. At least 16 different CDRs have been proposed. Only a few have been tested across multiple datasets. Some CDRs were reproducible, but none fulfilled the requirements for validation. Different definitions of outcome and the lack of rigorous methods for derivation probably explain why no validated CDR yet exists for children with febrile neutropenia. Summary A consensus definition of the best outcome in clinical practice is essential. It must then be followed by multiple and large-scale validations of a CDR that meets all methodological criteria, with high sensitivity and enough specificity to enable physicians to safely propose an outpatient management strategy for patients identified as at low risk of severe complications related to febrile neutropenia.