PURPOSE: Febrile neutropenia (FN) in pediatric patients with cancer can cause severe infections, and prompt antibiotics are warranted. Extrapolated from other populations, a time-to-antibiotic (TTA) metric of <60 minutes after medical center presentation was established, with compliance data factoring into pediatric oncology program national rankings. METHODS: All FN episodes occurring at Vanderbilt Children's Hospital (2007-February 2022) and a sample of episodes from Colorado Children's Hospital (2012-2019) were abstracted, capturing TTA and clinical outcomes including major complications (intensive care unit [ICU] admission, vasopressors, intubation, or infection-related mortality). Odds ratios (ORs) were adjusted for age, treatment center, absolute neutrophil count, hypotension presence, stem-cell transplant status, and central line type. RESULTS: A total of 2,349 episodes were identified from Vanderbilt (1,920) and Colorado (429). Only 0.6% (n = 14) episodes required immediate ICU management, with a median TTA of 28 minutes (IQR, 20-37). For the remaining patients, the median TTA was 56 minutes (IQR, 37-90), and 54.3% received antibiotics in <60 minutes. There were no significant associations between TTA (<60 or ≥60 minutes) and major complications (adjusted OR, 0.99 [95% CI, 0.62 to 1.59]; P = .98), and a TTA ≥60 minutes was not associated with any type of complication. Similarly, TTA, when evaluated as a continuous variable, was not associated with a major (OR, 0.99 [95% CI, 0.94 to 1.04]; P = .69) nor any other complication in adjusted analysis. CONCLUSION: There is no clear evidence that a reduced TTA improves clinical outcomes in pediatric oncology FN and thus it should not be used as a primary quality measure.

Background/Objectives: There remains a need for additional prognostic markers in classic follicular lymphoma (cFL) to identify aggressive disease. Immunohistochemical stains such as Ki-67, MYC, and p53 have shown variable associations with histologic grade and adverse outcomes. In this study, we aimed to assess intrafollicular Ki-67, MYC, and p53 expression in cFL via immunohistochemistry, quantified by both manual and digital methods, and evaluate their relation to histologic grade and clinical outcomes. Methods: We evaluated 37 cases of cFL from 2000 to 2019 and performed immunohistochemistry for Ki-67, MYC, and p53 on tumor microarray tissue. Stains were assessed within follicles by digital pathology means on QuPath software and via manual low-power estimates. Results:MYC expression was greater in FL3A compared to FL1–2 across all digital and manual scoring methods (all p < 0.05). Ki-67 and p53 expression did not differ by histologic grade group. No biomarker showed a significant association with adverse clinicopathologic features or outcomes, including FLIPI risk group, bulky disease, clinical stage, event-free survival, or overall survival. Manual and digital scores demonstrated strong correlations for all markers (ρ = 0.71–0.89, all p < 0.001). Conclusions: In our cohort, MYC expression was increased in FL3A compared to FL1–2, while no intrafollicular biomarker measurement was associated with adverse clinicopathologic features or clinical outcomes in exploratory analyses. These findings should be interpreted with caution in light of our limited cohort size. Strong concordance between manual and digital scoring supports the feasibility of digital IHC quantification in cFL.