{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:04:48Z","timestamp":1753869888292,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Febrile neutropenia (FN) episodes in sarcoma patients may be due to potentially life\u2010threatening microbiologically defined infection (MDI). Clinical decision rules (CDRs) such as the Australian\u2013UK\u2013Swiss (AUS) rule have been developed to risk\u2010stratify FN episodes, allowing for early discharge of patients at low risk of MDI. The AUS rule was validated in the multicentre Predicting Infectious Complications in Children with Cancer (PICNICC) FN episode dataset. However, similar paediatric CDRs perform poorly in teenage and young adult (TYA) cohorts, which comprise most young sarcoma patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were retrospectively collected for FN episodes of London Sarcoma Service patients aged 1\u201325\u00a0years diagnosed from 1 April 2020 to 31 March 2023. MDI rate was compared to the standard\u2010risk (acute lymphoblastic leukaemia) patients in published PICNICC data. Sensitivity and specificity for likely bacterial infection (LBI) with 95% confidence intervals were calculated for an AUS score \u22641.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 157 patients met inclusion criteria (median age 15.4\u00a0years, range: 5.2\u201325.9\u00a0years). Outcomes were available for 159\/160 FN episodes in 82 patients. IVADo had the highest rate of FN episodes per cycle: 23.5% [15.0%\u201334.9%] versus 18.8% [15.1%\u201323.1%] for MAP and 7.0% [5.4%\u20139.1%] for VDC\/IE. Twenty\u2010five of 159 (16%) FN episodes were blood culture\u2010positive, significantly lower than standard\u2010risk patients in the PICNICC dataset. The AUS score had a sensitivity of 62.9% [45.7%\u201378.2%] and a specificity of 29.8%[22.2%\u201339.0%] for LBI, with 13\/35 (38%) LBI episodes missed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, children and TYA with sarcomas are at lower risk of complications from FN, but the AUS rule performs poorly in this cohort. Better biomarker\u2010driven CDRs are needed for risk\u2010stratified FN management of these patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31651","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T12:33:37Z","timestamp":1741696417000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Performance of the Australian\u2013UK\u2013Swiss Clinical Decision Rule for Febrile Neutropenia in Children and Young Adults With Bone and Soft Tissue Sarcomas"],"prefix":"10.1002","volume":"72","author":[{"given":"Arun K.","family":"Mahapatra","sequence":"first","affiliation":[{"name":"Medical School University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikhilesh S.","family":"Sahana","sequence":"additional","affiliation":[{"name":"Medical School University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-0811","authenticated-orcid":false,"given":"Rachael E.","family":"Windsor","sequence":"additional","affiliation":[{"name":"Children and Young Persons Cancer Services, University College London Hospital NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1669-6666","authenticated-orcid":false,"given":"Thomas J.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Children and Young Persons Cancer Services, University College London Hospital NHS Trust  London UK"},{"name":"Department of Developmental Biology and Cancer University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30214-5"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01790-1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcped.2023.100116"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.28"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2009.06.003"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24076"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05654-z"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.8988"},{"key":"e_1_2_10_10_1","first-page":"100394","volume-title":"EClinicalMedicine","author":"Haeusler G. M.","year":"2020"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28580"},{"key":"e_1_2_10_12_1","unstructured":"Children's Cancer and Leukaemia Group (CCLG) \u201cManaging Febrile Neutropenia in the UK in 2020 Proposed New Management Pathway \u201dCCLG 2020."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2021-323254"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.05.027"},{"key":"e_1_2_10_15_1","unstructured":"Public Health England \u201cChildren Teenagers and Young Adults UK Cancer Statistics Report 2021 \u201dPublic Health England 2021."},{"key":"e_1_2_10_16_1","unstructured":"NHSN \u201cCentre for Disease Control (CDC) Bloodstream Infection Event (Central Line\u2010Associated Bloodstream Infection and Non\u2010Central Line Associated Bloodstream Infection) \u201dCDC 2024 https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/4psc_clabscurrent.pdf."},{"key":"e_1_2_10_17_1","unstructured":"\u201cCG151 Neutropenic Sepsis: Prevention and Management in People with Cancer \u201dNICE 2012."},{"key":"e_1_2_10_18_1","unstructured":"S.Aldiss R.Hollis B.Phillips andF.Gibson \u201cResearch Priorities in Children's Cancer. Final Report of the James Lind Alliance Priority Setting Partnership \u201dJames Lind Alliance 2023."},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050078"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12512"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.11.013"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00149-8"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(21)00337-0"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.31651","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T10:29:08Z","timestamp":1745404148000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.31651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/pbc.31651"],"URL":"https:\/\/doi.org\/10.1002\/pbc.31651","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"type":"print","value":"1545-5009"},{"type":"electronic","value":"1545-5017"}],"subject":[],"published":{"date-parts":[[2025,3,10]]},"assertion":[{"value":"2024-12-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31651"}}