Outcome of Tocilizumab Treatment in Febrile Neutropenic Children with Severe Sepsis/Septic Shock in a Single-Center Retrospective Case Series

Simple Summary Febrile neutropenia is common in children with hemato-oncological disease. It could be fatal, especially when severe sepsis/septic shock occurs. The aim of our retrospective study was to investigate the efficacy of tocilizumab on the outcome of febrile neutropenic children with severe sepsis/septic shock. We found that Il-6 blockade with tocilizumab is a potential therapeutic strategy for severe sepsis/septic shock in seven children with febrile neutropenia. Two of four (50%) patients receiving tocilizumab therapy needed pediatric intensive care unit (PICU) admission, whereas all three (100%) patients without tocilizumab therapy were admitted to the PICU. None of the four (0%) patients receiving tocilizumab therapy died of an episode of severe sepsis/septic shock. However, two of three (67%) patients without tocilizumab therapy died of rapid progression of multiple organ failure after the development of severe sepsis/septic shock. Further research to investigate the efficacy and long-term safety in a larger number of patients with a longer follow-up is needed.Abstract Purpose: To assess the efficacy of an IL-6 blockade with tocilizumab on treatment outcome of severe sepsis/septic shock in children with febrile neutropenia. Methods: We performed a retrospective study of febrile neutropenic patients younger than 18 years old who developed severe sepsis/septic shock at a single medical center between November 2022 and October 2023. Results: Seven patients with febrile neutropenia complicated with severe sepsis/septic shock were identified. Four of seven patients received tocilizumab in addition to standard of care. The median IL-6 level before administration of tocilizumab was 14,147 pg/mL (range: 672-30,509 pg/mL). All four patients successfully recovered from severe sepsis/septic shock. Three of seven patients received standard of care without tocilizumab. IL-6 levels were checked intwo2 patients, with a median of 1514.5 (range: 838-2191). Only one of three (33%) patients without tocilizumab therapy made a full recovery from severe sepsis/septic shock. The mortality rate was higher in patients without tocilizumab therapy compared to patients with tocilizumab therapy (67% vs. 0%). Conclusions: Administration of tocilizumab reduced mortality of severe sepsis/septic shock in children with febrile neutropenia. However, it warrants confirmation with a larger number of patients and a longer follow-up.