Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol)

In the IPD protocol, we will collect and synthesise IPD from multiple studies and examine the outcomes of episodes of febrile neutropenia as a consequence of their treatment for malignant disease. We will develop and evaluate a risk stratification model using hierarchical regression models to stratify patients by their risk of experiencing adverse outcomes during an episode. We will also explore specific practical and methodological issues regarding adaptation of established techniques of IPD meta-analysis of interventions for use in synthesising evidence derived from IPD from multiple studies for use in predictive modelling contexts.Our aim in using this model is to define a group of individuals at low risk for febrile neutropenia who might be treated with reduced intensity or duration of antibiotic therapy and so reduce the inconvenience and cost of these episodes, as well as to define a group of patients at very high risk of complications who could be subject to more intensive therapies. The project will also help develop methods of IPD predictive modelling for use in future studies of risk prediction.Children undergoing treatment for malignancy have an excellent chance of survival, with overall rates approaching 75% [1]. In most cases, children who die following treatment for cancer do so as a result of their disease, but despite huge improvements in supportive care, around 16% of deaths within 5 years of diagnosis are due to the complications of therapy [2,3]. One such life-threatening complication in immunocompromised children remains infection, which frequently manifests as the occurrence of fever with neutropenia [4].In adopting a policy of aggressive inpatient intravenous antibiotic use in such episodes, the mortality rate related to these episodes has improved dramatically (from 30% in the 1970s to 1% in the late 1990s) [4]. Intensive care management is required in less than 5% of cases [5-7], although a substantial proportion of children have complication