Blood, 1960, Vol. 16, No. 5, pp. 1609-1628.
© 1960 American Society of Hematology, Inc.
The Clinical Significance of Fever in Acute Leukemia
SPENCER O. RAAB 1,
PAUL D. HOEPRICH 1,
MAXWELL M. WINTROBE 1, and
GEORGE E. CARTWRIGHT 1
1 Department of Internal Medicine, University of Utah College of Medicine
and the Salt Lake County General Hospital. Dr. Raab was a Clinical Fellow of the American
Cancer Society 1957-1959.
1. The total course of acute leukemia in 55 patients managed in one clinic
disclosed 149 febrile episodes.
2. Fever occurred virtually only when the leukemia was in relapse.
3. Infection was the cause of fever in 102 of the 149 episodes of fever.
4. With survival after the onset of symptoms of acute leukemia beyond the
mean duration of life characteristic of that kind of acute leukemia, infection
appeared to be more often the cause of fever than when survival was less
than the mean for that kind of leukemia.
5. Fever due to infection could not be reliably differentiated from fever not
due to infection by either the height or character of the fever curve, or by
counting the absolute number of mature polymorphonuclear leukocytes in
the blood.
6. Infection causing febrile episodes was most successfully detected by
means of history, physical examination, chest roentgenogram, blood culture
and other cultures as indicated by the preceding maneuvers.
7. Consideration of the fever of acute leukemia from the point of view
of present day studies of the pathogenesis of fever did not clearly implicate
known mechanisms of pyrogenesis.
8. The interplay of state of leukemia, nature of infecting microorganism
and anti-infectious and antileukemic therapies is related to outcome in febrile episodes due to infections. The management of febrile episodes is
discussed.
9. Increased survival time in children with acute lymphoblastic leukemia
has not been accompanied by increased morbidity.
Submitted on March 21, 1960
Accepted on April 21, 1960
