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Martinez Lago, Nieves, Maria Vieito, Urbano Anido, Sonia Candamio, Rafael Lopez, Francisco J. Barón, Yolanda Vidal, et al. "Retrospective study of febrile neutropenia." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19505-e19505. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19505.
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e19505 Background: Although its mortality has decreased in the last years, neutropenic fever is still one of the most important oncological emergencies. Methods: We have assessed the epidemiological data on patients admitted or evaluated for neutropenic sepsis in a third level cancer center from January 2009 to December 2010. Results: We have found 68 patients who had at least one episode of febrile neutropenia, of them 66% were male and 34% female, and the mean age was 59 years. The performance status was 0 and 1 in 80% of patients and only 19% percent had serious comorbilities such as renal dysfunction, cirrhosis, diabetes mellitus or chronic pulmonary disease. 36% of our patients had a high risk neutropenic fever per MASCC criteria. The majority of patients were lung cancer (31%) breast cancer (22%); and gastrointestinal cancer (28%) and 53% where treated with palliative intention. The episodes of febrile neutropenia were more frequent in patients in first line of treatment (72%) and first cycle of any treatment (42%). 8% of patients were treated with chemorradiation and 35% of the patients were receiving prophylaxis with GCSF. There was no found the source of the infection in 45% of patients. 25% had positive cultures. The porcetaje of infections with gram-positive and-negative was very similar. Patients were treated with a combination of amikacine and ceftacidime in 63% of times, further addition of vancomicine or antifungical therapies were only needed in minority of patients, 88% percent of patients received granulocyte stimulating factors. The mean duration of the neutropenia was of 2 days. Following chemotherapy treatment doses were reduced in 44% of patients and delayed in 26%. Thirteen percent of patients received secondary prophylaxis with GCSF, treatment regimen changed was changed in only 2% of patients and 29% received no further treatment. Conclusions: The mortality rate was of 3%, and the time of hospitalization was short (mean of 7 days). Febrile neutropenia remains a serious complication that we have to decrease.
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Nucci, Marcio. "How I treat febrile neutropenia." Mediterranean Journal of Hematology and Infectious Diseases 13, no. 1 (February 26, 2021): e2021025. http://dx.doi.org/10.4084/mjhid.2021.025.
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The management of febrile neutropenia is a backbone of the treatment of patients with hematologic malignancies, and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics discussed include antibacterial and antifungal prophylaxis, the initial workup for fever, the choice of the empiric antibiotic regimen and its modifications, and criteria for discontinuation. For each of these questions, I review the literature and present my perspective.
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Rattanathammethee, Thanawat, Pokpong Piriyakhuntorn, Sasinee Hantrakool, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong, Adisak Tantiworawit, Lalita Norasetthada, et al. "Gut Microbiota Profiles of Treatment-Naïve Adult Acute Myeloid Leukemia Patientswith Neutropenic Fever during Intensive Chemotherapy." Blood 136, Supplement 1 (November 5, 2020): 38–39. http://dx.doi.org/10.1182/blood-2020-140936.
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Background : The intestinal bacterial flora of febrile neutropenic patients has been found to be significantly diverse and may play a role in clinical decisions regarding antimicrobial de-escalation with predictive complications. However, there are few reports of microbiota alteration of adult acute myeloid leukemia (AML) patients. Methods : Stool samples of each treatment-naïve AML patient were collected the day before the initiation of induction chemotherapy (pretreatment), on the first date of neutropenic fever and first date of bone marrow recovery. Bacterial DNA was extracted from stool samples and bacterial 16s ribosomal RNA genes were sequenced by next-generation sequencing. Relative abundance, overall richness, Shannon's diversity index and Simpson's diversity index were calculated. Results : Ten AML patients (4 men and 6 women) were included with a median age of 39 years (range: 19-49). Twenty-four stool samples were collected and assigned into three groups: (1) pretreatment (n = 10); (2) first date of febrile neutropenia (n=9); and (3) first date of bone marrow recovery (n=5). All of patients developed febrile neutropenia; three patients had detectable infectious organisms and all of these cases had invasive pulmonary aspergillosis with two being co-infected with Pseudomonas pneumonia and Escherichia coli septicemia. Median absolute neutrophil count was 2.85 x 109/L (range: 1.42-7.67 x 109/L), 0.04 x 109/L (range: 0.01-0.43 x 109/L) and 3.65 x 109/L (range: 2.09-5.78 x 109/L) at pretreatment, first date of febrile neutropenia and first date of bone marrow recovery, respectively. At the phylum level, Firmicutes dominated over the period of neutropenic fever, subsequently declining after bone marrow recovery a pattern in contrast to that shown by Bacteroidetes and Proteobacteria. At the genus level, Enterococcus was more abundant in the febrile neutropenia period compared to pretreatment (mean difference of 20.2, [95%CI (5.9, 34.6)]; P <0.01) whileBacteroides and Escherichia notably declined during the same period (mean difference of -11.7, [95%CI (-21.9, -1.4)]; P= 0.027 and -11.6, [95%CI (-22.7, -0.4)]; P = 0.034, respectively). At the operational taxonomic units (OTUs) level, there was a significantly higher level of overall richness in the pretreatment period than in the febrile neutropenic episode (mean OTUs of 203.1 vs. 131.7; P = 0.012). Both of the diversity indexes of Shannon and Simpson showed a significant decrease in the febrile neutropenic period. Conclusions : Adult AML patients with a first episode of febrile neutropenia after initial intensive chemotherapy demonstrated a significant decrease in gut microbiota diversity and the level of diversity remained constant despite recovery of bone marrow. Figure Disclosures No relevant conflicts of interest to declare.
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Weissinger, F., and W. J. Heinz. "Prevention and treatment of febrile neutropenia." memo - Magazine of European Medical Oncology 5, no. 1 (April 2012): 30–34. http://dx.doi.org/10.1007/s12254-012-0335-2.
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Pichereau, Solen, Anne Le Louarn, Thierry Lecomte, Hélène Blasco, Chantal Le Guellec, and Hélène Bourgoin. "Cost-Effectiveness of UGT1A1*28 Genotyping in Preventing Severe Neutropenia Following FOLFIRI Therapy in Colorectal Cancer." Journal of Pharmacy & Pharmaceutical Sciences 13, no. 4 (January 3, 2011): 615. http://dx.doi.org/10.18433/j3wk5s.
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PURPOSE: Functional polymorphisms of the UGT1A1 gene, particularly the UGT1A1*28 variant, are associated with the severity of the bone marrow suppression in patients with metastatic colorectal cancer receiving irinotecan. This study assesses the cost-effectiveness of screening for UGT1A1*28 polymorphism associated with primary prophylactic Granulocytes Colony Stimulating Factor in patients homozygous for the *28 allele. The effectiveness was estimated based on the number of neutropenia avoided. METHODS: We modelled a theoretical population treated with combined 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) for metastatic colorectal cancer. A decision tree simulated the health outcomes, measured by the prevalence of neutropenic events for two strategies, with or without UGT1A1 genotype screening. The model incorporated direct hospital costs and was validated with a sensitivity analysis. We calculated the cost-effectiveness ratio: CE=∆C / ∆E = "genotyping" cost – "no genotyping" cost / number of febrile neutropenia avoided. RESULTS: In the "genotyping strategy", the cost to avoid one febrile neutropenia event per 1000 patients treated was € 942.8 to € 1090.1. The sensitivity analysis showed a better CE ratio of € 733.4 to € 726.6 per febrile neutropenic event avoided.CONCLUSIONS: UGT1A1 genotype screening before irinotecan treatment is a cost-efficient strategy for the hospital. Systematic genotyping prior to chemotherapy, and administration of CSF in patients homozygotes for the *28 allele allow to avoid 91 febrile neutropenias at an acceptable cost.
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Nyatsanza, Ignatius, Irum Khan, Jennifer Windhorst, Nicole Gerardo, Kasandra Cadman, LeeAnn Valero, Eileen Knightly, Lawrence Eric Feldman, William Galanter, and Neeta K. Venepalli. "Timely antibiotic administration in febrile neutropenia." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 204. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.204.
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204 Background: The University of Illinois currently lacks a standard process to ensure timely antibiotic administration for patients with febrile neutropenia. The Infectious disease society of America (IDSA) guidelines recommend administration of antibiotics within two hours. Given the variability in patient encounters, we sought to implement an early identification and interventional strategy in the ambulatory setting for febrile neutropenic patients. A retrospective chart review over 10 weeks demonstrated that of 40 patients diagnosed with neutropenia 15 % (N = 6) had febrile neutropenia. Of these 6 patients, 50% (N = 3) received antibiotics within the IDSA time frame. We aimed to increase the percentage of febrile neutropenic patients receiving antibiotics within 2 hours from 50% to 100% in 8 weeks. Methods: A focus group at our quarterly morbidity mortality and improvement conference brainstormed a list of causes of delay in antibiotic initiation based on an index case discussion. A task force generated a pareto chart after affinity sorting the prior list, and created actual and ideal process maps, from identification of neutropenic patients to patient disposition. A standard operative protocol (SOP) was developed involving the creation and implementation of an electronic provider generated neutropenia check list triggering specific actions per IDSA recommendations, and a standardized order set including STAT cultures, and STAT antibiotics. Results: The febrile neutropenia SOP will be piloted over an 8 week period starting in early November in four ambulatory settings. The primary outcome data is the time from event to antibiotic administration. Process data will include time from event to antibiotic order, time from antibiotic order to administration and compliance with high risk neutropenic check list. We plan to assess our interventions every 3-4 weeks, and pilot at least 2 PDSA cycles within the next 8 weeks. Conclusions: Although febrile neutropenia is a recognized medical emergency with clear guidelines on treatment, not all patients may receive antibiotics within the appropriate time frame. It is therefore imperative for institutions to be aware of their level of IDSA compliance and implement appropriate quality improvements as required.
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Strojnik, Ksenija, Ksenija Mahkovic-Hergouth, Barbara Jezersek Novakovic, and Bostjan Seruga. "Outcome of severe infections in afebrile neutropenic cancer patients." Radiology and Oncology 50, no. 4 (December 1, 2016): 442–48. http://dx.doi.org/10.1515/raon-2016-0011.
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Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.
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Naeem, Doaa, Majed Alshamrani, Mohammed Aseeri, and Mansoor Khan. "Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines." Pharmacy 6, no. 3 (August 10, 2018): 83. http://dx.doi.org/10.3390/pharmacy6030083.
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Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.
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Lingaratnam, Senthil, Leon J. Worth, Monica A. Slavin, Craig A. Bennett, Suzanne W. Kirsa, John F. Seymour, Andrew Dalton, et al. "A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment." Australian Health Review 35, no. 4 (2011): 491. http://dx.doi.org/10.1071/ah10951.
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Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care. Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach. Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients. What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications. What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia. What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.
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Morgan, Jessica E. "Fifteen minute consultation: Fever in children being treated for cancer." Archives of disease in childhood - Education & practice edition 104, no. 3 (August 13, 2018): 124–28. http://dx.doi.org/10.1136/archdischild-2017-314718.
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Fever is a common symptom in children receiving treatment for cancer. Clinicians and families are most concerned about febrile neutropenia, though non-neutropenic fever often causes more challenging treatment dilemmas. This article provides a structured approach to the initial assessment, examination, investigation and risk assessment of children with fever during treatment for childhood cancer. Non-neutropenic fever in children with cancer is not well researched. There are no systematic reviews of its management and no National Institute for Health and Care Excellence (NICE) (or other international) guidance about what to do. Features to consider when managing non-neutropenic fever are discussed. Febrile neutropenia, meanwhile, is an oncological emergency and requires management using standard sepsis principles including administration of broad-spectrum antibiotics. Relevant NICE guidance provides a clear structure for treatment. Ongoing management depends on the response to initial treatment.
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Minuk, Leonard A., Ian Chin-Yee, Kang Howson-Jan, Reinhard Lohmann, Alejandro Lazo-Langner, Vinai C. Bhagirath, and Joy Mangel. "Treatment of Hodgkin Lymphoma without G-CSF Does Not Increase the Risk of Febrile Neutropenia." Blood 114, no. 22 (November 20, 2009): 2502. http://dx.doi.org/10.1182/blood.v114.22.2502.2502.
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Abstract Abstract 2502 Poster Board II-479 Background: Patients with Hodgkin Lymphoma (HL) being treated with ABVD chemotherapy frequently develop neutropenia, though the complication of febrile neutropenia is relatively uncommon. In most cancer centres, including our own until recently, the presence of neutropenia on the planned day of chemotherapy administration (absolute neutrophil count (ANC) <1.5×109/L) often resulted in delays in chemotherapy administration and/or dose attenuation, plus the addition of G-CSF prophylaxis through all subsequent cycles of chemotherapy. G-CSF is costly and it can cause side effects such as bone pain. There is also some suggestion in the literature that G-CSF may increase the risk of bleomycin lung toxicity (BLT). Several retrospective studies have reported that full dose ABVD can be safely administered to patients without routine G-CSF support, regardless of the neutrophil count on the day of treatment. Based on this data, our centre decided to change the practice of routinely delaying chemotherapy and starting G-CSF prophylaxis in neutropenic patients, and to prospectively monitor the safety of this practice change. We present the results of our planned interim safety analysis. Methods: Newly diagnosed patients with HL with no bone marrow involvement and no significant co-morbidities were enrolled and followed prospectively throughout their treatment. ABVD chemotherapy was administered every two weeks without dose delay or attenuation and without the addition of G-CSF, regardless of the neutrophil count on the day of treatment. Dose reductions were permitted for non-hematological toxicities. G-CSF was added as secondary prophylaxis to all subsequent cycles in patients who developed febrile neutropenia. We also retrospectively reviewed the charts of patients with HL treated with ABVD at our centre from 2004-2007 (prior to practice change) and collected data on the incidence of neutropenia, febrile neutropenia, G-CSF use and BLT. Continuous variables were analysed using the Mann Whitney U test and dichotomous variables using Chi squared analysis. Results: Since September 2008, 17 patients have been enrolled in the study. No patients met criteria for exclusion. A total of 149 ‘doses' (half cycles) of ABVD have been administered so far. Table 1 shows demographic information on the prospective and retrospective patient populations, as well as rates of neutropenia, febrile neutropenia, and BLT. Almost all study patients (15/17, 88%) had documented neutropenia at some point during treatment, the majority (13 patients) as early as cycle 1B. Excluding cycle 1A, the median neutrophil count on day of treatment was 1.3×109/L. Half of the chemotherapy doses (74/149) were administered with an ANC <1.5×109/L; one third (52 doses) with grade 3/4 neutropenia. None of the chemotherapy was dose reduced (except for non-hematologic toxicity) and most of the treatments were given on time, with a median dose interval of 14 days. One patient developed BLT after cycle 4B. There was 1 episode of low risk febrile neutropenia occurring after cycle 3B in which no causative organism was identified. This patient received all subsequent chemotherapy with G-CSF prophylaxis with no further episodes of neutropenic fever. Conclusion: This interim analysis shows that ABVD chemotherapy can be safely administered to patients with HL without dose attenuation, delays or the routine use of G-CSF prophylaxis in the setting of neutropenia. This practice change resulted in a similar very low rate of febrile neutropenia (<1%), but significant reductions in cost and dose delay secondary to neutropenia. Disclosures: No relevant conflicts of interest to declare.
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Salako, Omolola, Kehinde Sharafadeen Okunade, Adeoluwa Akeem Adeniji, Gabriel Fagbenro, and Oluwasegun Afolaranmi. "Chemotherapy-induced neutropenia among breast cancer patients presenting to a tertiary hospital in Nigeria." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e12523-e12523. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e12523.
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e12523 Background: Neutropenia and febrile neutropenia are major dose-limiting adverse effects of systemic cancer chemotherapy. It has been associated with significant morbidity and mortality, and high costs of management, and treatment breaks in cancer patients especially in resource-limited environments leading to poorer outcomes. Chemotherapy-induced neutropenia is an established complication of breast cancer treatment, however, there is paucity of information on the exact magnitude of the condition. This study assessed the prevalence of neutropenia and febrile neutropenia, while identifying their associated factors. Methods: A cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a two-year period. Sociodemographic, clinical and haematological data was obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected after each course of chemotherapy. The National Cancer Institute Common Terminology CTCAE version 4.03 was used to assess febrile neutropenia, neutropenia and its severity. Results: The prevalence of neutropenia and febrile neutropenia among the patients was 31.9% and 5.3% respectively. Throughout all courses of chemotherapy, there were neutropenic episodes 11.4% (57/502) with mild neutropenia 6.6%, moderate 3.4% and severe 1.4%. Prevalence of neutropenia decreased with increasing chemotherapy courses, with prevalence after first course being 14.2% and last course 4.9%. Associated risk factors for developing neutropenia include increasing age ( p = 0.014), ECOG performance score > 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusions: One in three breast cancer patients developed neutropenia while on chemotherapy. The use of prophylactic G-CSF after each course of chemotherapy should be a routine practice, especially among elderly patients, unstable patients, and those with bone metastasis.
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Devi, Yumkham Monica, Amit Sehrawat, Prasan Kumar Panda, and Uttam Kumar Nath. "Febrile neutropenia due to COVID-19 in an immunocompetent patient." BMJ Case Reports 14, no. 4 (April 2021): e242683. http://dx.doi.org/10.1136/bcr-2021-242683.
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While lymphopenia has been a common finding in COVID-19 infection, particularly in severe cases, febrile neutropenia has been very rarely reported in immunocompetent patients with COVID-19. Herein, we report the case of a 76-year-old hypertensive and diabetic man who was hospitalised with severe COVID-19 infection and developed delayed-onset severe neutropenia with neutropenic fever, which responded to treatment with antibiotics and granulocyte colony-stimulating factor. This case highlights the importance of identifying a rare complication (febrile neutropenia on the fifth week) of COVID-19 infection in hospitalised patients by intensive monitoring and aggressive management for favourable outcomes.
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Akter, Mehnaz, Afiqul Islam, Akm Amirul Morshed, Zannat Ara, SM Rezanur Rahman, Md Tanvir Ahmmed, and Md Bani Yeamin. "Efficacy and Safety of Piperacillin-Tazobactam and Cefepime as Empirical Therapy for Febrile Neutropenic Children with Acute Lymphoblastic Leukaemia (ALL)." Bangladesh Journal of Child Health 45, no. 2 (June 9, 2022): 83–88. http://dx.doi.org/10.3329/bjch.v45i2.60079.
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Background: Infection is a major clinical challenge in ALL treatment. Prompt administration of empirical antibiotic in febrile neutropenic patients has reduced the mortality. Both Cefepime or Piperacillin-Tazobactam has been used as empirical treatment.
Objective: To compare the efficacy and safety between Piperacillin-Tazobactam with Cefepime in febrile neutropenic children with ALL.
Materials and methods: This randomized study was conducted from August 2015 to August 2016 in BSMMU. Sixty one episodes of febrile neutropenia in children with ALL, aged 0 to18 years were included in this study. Patients were randomized into two groups. One group received Piperacilln/Tazobactam and another group received Cefepime and data of 60 febrile neutropenic episodes were analyzed.
Results: Febrile neutropenic episodes in the Piperacillin/Tazobactam group were 28 and in Cefepime group was 32 episodes and 34(57.63%) were male and 25 (42.37%) female. Median age was 5 years and 38(62.3%) neutropenic episodes were in induction phase. Majority had fever without focus 21(35%). Microorganisms isolated in 13 (21.66%) patients and majority 6 (46.15%) had blood infection. Most of the isolated organisms were Gram negative 11(84.61%). Overall treatment success without modification in the Piperacillin/Tazobactam group was 17(60.7%) and in Cefepime group 18 (56.3%) and that comparison was not statistically significant (p= 0.732). Significant difference was also not found comparing the mean duration of fever, neutropenia and hospital stay.
Conclusion: Both Piperacillin/Tazobactam and Cefepime were found effective and safe as an empirical therapy for febrile neutropenic children with ALL.
BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 83-88
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Kukec, Renata Rezonja, Iztok Grabnar, Tomaz Vovk, Ales Mrhar, Viljem Kovac, and Tanja Cufer. "Febrile neutropenia in chemotherapy treated small-cell lung cancer patients." Radiology and Oncology 49, no. 2 (June 1, 2015): 173–80. http://dx.doi.org/10.2478/raon-2014-0050.
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Abstract Background. Chemotherapy with platinum agent and etoposide for small-cell lung cancer (SCLC) is supposed to be associated with intermediate risk (10-20%) of febrile neutropenia. Primary prophylaxis with granulocyte colonystimulating factors (G-CSFs) is not routinely recommended by the treatment guidelines. However, in clinical practice febrile neutropenia is often observed with standard etoposide/platinum regimen. The aim of this analysis was to evaluate the frequency of neutropenia and febrile neutropenia in advanced SCLC patients in the first cycle of standard chemotherapy. Furthermore, we explored the association between severe neutropenia and etoposide peak plasma levels in the same patients. Methods. The case series based analysis of 17 patients with advanced SCLC treated with standard platinum/etoposide chemotherapy, already included in the pharmacokinetics study with etoposide, was performed. Grade 3/4 neutropenia and febrile neutropenia, observed after the first cycle are reported. The neutrophil counts were determined on day one of the second cycle unless symptoms potentially related to neutropenia occurred. Adverse events were classified according to Common Toxicity Criteria 4.0. Additionally, association between severe neutropenia and etoposide peak plasma concentrations, which were measured in the scope of pharmacokinetic study, was explored. Results. Two out of 17 patients received primary GCS-F prophylaxis. In 15 patient who did not receive primary prophylaxis the rates of both grade 3/4 neutropenia and febrile neutropenia were high (8/15 (53.3%) and 2/15 (13.3%), respectively), already in the first cycle of chemotherapy. One patient died due to febrile neutropenia related pneumonia. Neutropenic events are assumed to be related to increased etoposide plasma concentrations after a standard etoposide and cisplatin dose. While the mean etoposide peak plasma concentration in the first cycle of chemotherapy was 17.6 mg/l, the highest levels of 27.07 and 27.49 mg/l were determined in two patients with febrile neutropenia. Conclusions. Our study indicates that there is a need to reduce the risk of neutropenic events in chemotherapy treated advanced SCLC, starting in the first cycle. Mandatory use of primary G-CSF prophylaxis might be considered. Alternatively, use of improved risk models for identification of patients with increased risk for neutropenia and individualization of primary prophylaxis based on not only clinical characteristics but also on etoposide plasma concentration measurement, could be a new, promising options that deserves further evaluation.
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Viscoli, Claudio, and Elio Castagnola. "Treatment of febrile neutropenia: what is new?" Current Opinion in Infectious Diseases 15, no. 4 (August 2002): 377–82. http://dx.doi.org/10.1097/00001432-200208000-00004.
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Gottlieb, Michael, Alex Koyfman, and Brit Long. "Outpatient Treatment for Low‐Risk Febrile Neutropenia." Academic Emergency Medicine 26, no. 12 (September 5, 2019): 1393–94. http://dx.doi.org/10.1111/acem.13847.
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Jándula, Barbara M., Rodrigo Martino, Mercedes Gurgi, Rosa Manteıga, and Jorge Sierra. "Treatment of Febrile Neutropenia with Cefepime Monotherapy." Chemotherapy 47, no. 3 (2001): 226–31. http://dx.doi.org/10.1159/000063226.
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Cerchione, Claudio, Davide Nappi, Alessandra Romano, and Giovanni Martinelli. "Pegfilgrastim in Supportive Care of Hodgkin Lymphoma." Cancers 14, no. 17 (August 23, 2022): 4063. http://dx.doi.org/10.3390/cancers14174063.
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Neutropenia and febrile neutropenia are common and potentially life-threating events associated with chemotherapy treatment in Hodgkin lymphoma (HL). Neutropenia-related infectious events could be an issue both for direct clinical consequences and for delay in treatment delivery, affecting final outcomes in a potentially highly curable disease. Pegfilgrastim is the pegylated form of filgrastim, the recombinant form of human G-CSF, capable of prevent and mitigate neutropenic effects of chemotherapy, when adopted as primary prophylaxis in several hematological malignancies. No updated version of major international guidelines provides clear indication on prophylaxis use of pegfilgrastim in HL to prevent febrile neutropenia episodes in HL. Moreover, to date, scarce and non-uniform clinical experiences evaluating pegfilgrastim as prophylaxis in HL are present in the literature. Herein, we propose a brief summary of the literature data about efficacy and safety of the use of pegfilgrastim as primary prophylaxis in HL during chemotherapy treatment.
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Tek, Ibrahim, Selami Kocak Toprak, Efe Hasdemir, Samed Rahatli, and Aysegül Yesilkaya. "Influence of Febrile Neutropenia Period on Plasma Viscosity at Malignancy." Scientific World Journal 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/507270.
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Cancer, chemotherapy, and infections all together make changes in blood rheology and may affect the defense mechanisms by changing the thrombocyte function and endothelial cell. We have examined changes of blood rheology on plasma viscosity to put on probable following criteria for starting the treatment of febrile neutropenia immediately. A total of 27 postchemotherapy patients (16 males and 11 females) with febrile neutropenia diagnosed according to international guidelines have been included into the study. The plasma viscosity of the patients whose febrile neutropenia has been successfully treated was also measured to assess the impact of the duration of neutropenia on viscosity. The plasma viscosities of the patients were significantly higher during neutropenic episode than in nonneutropenic state () except for alkaline phosphatase. All study parameters, particularly acute phase reactants, were statistically similar during both states. In the correlation of analysis with study parameters and stages, significant correlation was not observed between plasma viscosity alteration and leukocyte-neutrophil alteration, also other study parameters. We have demonstrated significantly elevated plasma viscosity in our patients during febrile neutropenic episode. Despite normal values of various parameters known to trigger plasma viscosity, particularly fibrinogen, it can be easily argued that the main mechanism may be the endothelial injury during infectious process and immune response mediated microcirculatory blood flow alterations.
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Dimitrijevic, Jelena, Snezana Bosnjak, Ana Vidovic, and Marina Nikitovic. "Comprehensive evaluation of risk factors for the development and complications of chemotherapy-induced febrile neutropenia." Srpski arhiv za celokupno lekarstvo, no. 00 (2022): 54. http://dx.doi.org/10.2298/sarh211109054d.
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Febrile neutropenia is a serious adverse effect of chemotherapy. It can lead to complications and death as well as delays in treatment, chemotherapy dose reductions, compromised treatment efficacy and reduced survival. The assessment of the patient-related risk factors plays a significant role in the prevention of febrile neutropenia and its complications. In the case of intermediate-risk chemotherapy, the patient-related factors contribute to the estimation of an overall febrile neutropenia risk as well as to timely planning of primary prophylaxis using growth factors. Patients presenting with febrile neutropenia undergo a detailed initial risk assessment for serious complications so that an appropriate treatment can be selected. Recommendations given by the guidelines outline the classification of and risk factors for febrile neutropenia complications. The usage of patient-related factors and validated tools for the risk assessment of complications makes it possible to optimize the treatment for each patient and to reduce the risk of morbidity and mortality due to FN.
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Yetmar, Zachary A., Prakhar Vijayvargiya, Pritish Tosh, and Mary J. Kasten. "2676. Effect of β-Lactam Allergy on Appropriateness of Antibiotic Use in Patients with Febrile Neutropenia." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S939. http://dx.doi.org/10.1093/ofid/ofz360.2354.
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Abstract Background Over 80% of patients with hematologic malignancies develop some form of infectious complication, most commonly febrile neutropenia. Patients with febrile neutropenia have 10% mortality, which increases if antibiotic administration is delayed past 30 minutes. Studies have suggested β-lactam allergy may delay administration of antibiotic while putting patients at greater risk for inappropriate antibiotic choice and adverse effects stemming from this. We sought to describe the risks associated with β-lactam allergy in the neutropenic population. Methods We conducted a retrospective, descriptive study from January 2016 to December 2017 identifying patients with febrile neutropenia and a reported history of β-lactam allergy. Baseline characteristics, allergy data, treatment data, and outcomes were collected and analyzed. Results We identified 31 patients with febrile neutropenia and β-lactam allergy during this time period. Etiologies of neutropenia were hematologic malignancy (61.2%), stem cell transplantation (12.9%), solid-organ malignancy (22.6%), and autoimmune (3.3%). Reported reactions to β-lactams were rash (41.9%), hives (9.7%), anaphylaxis (3.2%), other (9.7%), and unknown (35.5%). Average time to antibiotic administration was 142.5 minutes. Antibiotic choice was cefepime (61.3%), piperacillin–tazobactam (6.5%), carbapenem (22.6%), fluoroquinolone (6.5%), cefepime and fluoroquinolone (3.2%), and vancomycin (58.1%). 51.6% received initial antibiotics consistent with the 2010 IDSA guidelines. Six patients underwent penicillin skin testing, all negative. 1 patient developed C. difficile infection, 1 developed MRSA colonization, and 3 developed VRE colonization. Mortality was 3.2% at 30 days and 16.1% at 90 days. Conclusion Our study estimated the antibiotic usage patterns and outcomes in patients with febrile neutropenia and reported β-lactam allergy. This showed low adherence to an established guideline for antibiotic choice in these patients. With rising antimicrobial resistance, there is a need to develop strategies to reduce inappropriate antimicrobial use, especially in patients with febrile neutropenia. Preemptive β-lactam allergy evaluation warrants further evaluation in the neutropenic population. Disclosures All authors: No reported disclosures.
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Mitchell, P. L., B. Morland, M. C. Stevens, G. Dick, D. Easlea, L. C. Meyer, and C. R. Pinkerton. "Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients." Journal of Clinical Oncology 15, no. 3 (March 1997): 1163–70. http://dx.doi.org/10.1200/jco.1997.15.3.1163.
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PURPOSE Infection in neutropenic patients is potentially life-threatening and carries important implications for hospital resource use. Prophylactic administration of cytokines may reduce the severity of neutropenia, but involves the treatment of all patients for the possible benefit of a minority. This study evaluates whether treatment with cytokines in the setting of established febrile neutropenia will influence outcome and be potentially more cost-effective. PATIENTS AND METHODS In a double-blind study, pediatric patients with fever and severe neutropenia were randomized to receive granulocyte colony-stimulating factor ([G-CSF] filgrastim; 5 microg/kg/d) or placebo, in addition to antibiotics. The study protocol required a resolution of fever and a neutrophil count > or = 0.2 x 10(9)/L for hospital discharge. Patients could be randomized for up to four independent febrile episodes. A total of 186 episodes of febrile neutropenia were investigated. RESULTS Patients randomized to G-CSF had a shorter hospital stay (median, 5 v 7 days; P = .04) and fewer days of antibiotic use (median, 5 v 6 days; P = .02). G-CSF-treated patients also had more rapid neutrophil recovery and higher neutrophil levels at discharge. The 2-day reduction in hospital stay reduced the median bed cost by 29% per patient admission (P = .04). CONCLUSION Under the clinical guidelines of our institution, the use of G-CSF in the treatment of established febrile neutropenia produced a small but significant reduction in the time that children required antibiotics and hospital admission, with possible cost savings.
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Le Piane, Francesca, Sandra AN Walker, Scott E. Walker, Nina Lathia, Carlo De Angelis, and Andrew Simor. "Mortality in a Heterogeneous Population of Low-Risk Febrile Neutropenic Patients Treated Initially with Cefazolin and Tobramycin." Canadian Journal of Infectious Diseases and Medical Microbiology 20, no. 4 (2009): e145-e152. http://dx.doi.org/10.1155/2009/631969.
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BACKGROUND: At Sunnybrook Health Sciences Centre in Toronto, Ontario, the recommended empiric regimen for febrile neutropenia has been cefazolin and tobramycin for at least 25 years. However, we had no objective data to reassure us that patient mortality had not increased over the past five years.METHODS: A retrospective chart review of 48 episodes occurring in 44 patients admitted for the treatment of febrile neutropenia secondary to chemotherapy in 2002, and initially managed with cefazolin and tobramycin was conducted. Prospective data from 48 episodes in 2007 had previously been collected. Patients who developed febrile neutropenia while in hospital were excluded. The primary objective of the present study was to compare the all-cause mortality in 2007 with that from 2002.RESULTS: There were no statistically significant differences between the groups (P>0.05). All-cause mortality in 2007 was 8.3% (four of 48) compared with 10.4% (five of 48) in 2002 (P=1). All deaths occurred in patients considered to be at high risk according to the Talcott score.CONCLUSION: Mortality has not increased in the past five years with the use of empiric cefazolin and tobramycin for the treatment of patients admitted with febrile neutropenia at Sunnybrook Health Sciences Centre. Rates are comparable with those reported in the literature for similar patients. The results of the present study provide reassurance that the regimen continues to be effective for lower-risk febrile neutropenic patients.
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Villafuerte-Gutierrez, Paola, Lucia Villalon, Juan E. Losa, and Cesar Henriquez-Camacho. "Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update." Advances in Hematology 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/986938.
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Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.
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Oshima, Kumi, Yoshinobu Kanda, Yuki Asano-Mori, Hiroyuki Sato, Takuro Watabane, Noriko Hosoya, Koji Izutsu, et al. "Empiric or Presumptive Anti-Aspergillus Treatments for Allogeneic Hematopoietic Stem Cell Transplant Recipients with Sustained Febrile Neutropenia." Blood 108, no. 11 (November 16, 2006): 5288. http://dx.doi.org/10.1182/blood.v108.11.5288.5288.
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Abstract Background: Although the onset of invasive pulmonary aspergillosis (IPA) after allogeneic hematopoietic stem cell transplantation (HSCT) was bimodal, IPA early after HSCT has become less frequent, partly due to the shortening of neutropenic periods by the use of peripheral blood stem cells or colony-stimulating factors. Therefore, the validity of empiric anti-Aspergillus treatments based on sustained febrile neutropenia according to the IDSA guideline should be re-evaluated. Patients and Methods: We retrospectively reviewed the clinical records of 114 adult patients who underwent allogeneic HSCT between September 2002 and December 2005 in HEPA-filtered clean rooms at the University of Tokyo Hospital. Fluconazole at 200 mg/day was given as anti-Candida prophylaxis. In general, anti-Aspergillus agents were not started empirically, but presumptively started after the detection of positive Aspergillus antigen, positive beta-D-glucan, halo-sign on chest X-ray or CT-scan, and so on, associated with sustained febrile neutropenia. For the definition of early IPA, we employed proven or probable IPA according to the EORTC/MSG criteria that developed between the day of HSCT and seven days after engraftment. Results: All but two who experienced early death showed neutrophil engraftment at a median of 16.5 days after HSCT. Although 15 patients developed IPA after HSCT, early IPA was observed only in 2 (1.8 %) patients. Among 73 patients who experienced sustained febrile neutropenia for more than 7 days before engraftment, we empirically started anti-Aspergillus agents in 13 patients a median of 9 days after the development of febrile neutropenia, whereas fluconazole was continued in 60 patients who had febrile neutropenia for 15 days in median. Four of the 60 patients received presumptive anti-Aspergillus therapy, one of whom developed probable IPA after the initiation of treatment. There was another patient who received anti-Aspergillus treatment only after the development of probable IPA because he showed no prior signs for presumptive therapy. There was no difference in the incidence of early IPA between patients who received empiric anti-Aspergillus therapy and those who did not (0% vs. 3.3%, P>0.99). The two patients who developed early probable IPA were successfully treated with anti-Aspergillus agents. Conclusions: These findings throw doubt on the validity of empiric anti-Aspergillus treatments for allogeneic HSCT recipients with sustained febrile neutropenia, provided that they are treated in clean units with anti-Candida prophylaxis. A randomized controlled trial is warranted to compare empiric and presumptive anti-Aspergillus treatments for allogeneic HSCT recipients with sustained febrile neutropenia.
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Jakob, Carolin, Annika Classen, Melanie Stecher, Sandra Fuhrmann, Bernd Franke, Frieder Fuchs, Sarah Walker, Oliver Cornely, and Jörg Janne Vehreschild. "2187. Prediction of Patient Outcome During Febrile Neutropenia Despite Anti-infective Treatment Using Machine Learning Algorithms." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S744. http://dx.doi.org/10.1093/ofid/ofz360.1867.
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Abstract Background Clinical management of prolonged febrile neutropenia despite broad-spectrum empirical antibacterial treatment is a clinical challenge, as standard empirical treatment has failed and a broad spectrum of differential diagnoses has to be considered. Growing prevalence of multi-resistant bacteria and fungi has made a balanced choice of effective anti-infective treatment more difficult. A reliable prediction of complications could indicate options for treatment optimization. Methods We implemented a supervised machine learning approach to predict death or admission to intensive care unit within 28 days in cancer patients with prolonged febrile neutropenia (neutrophils < 500/mm3 and body temperature ≥ 38°C longer than 3 days). We analyzed highly granular retrospective medical data of the Cologne Cohort of Neutropenic Patients (CoCoNut) between 2008 and 2014. Random forest and 10-fold cross-validation were used for classification. The neutropenic episodes from 2014 were used for evaluation of prediction. Results In total, 927 episodes of prolonged febrile neutropenia (median age 52 years, interquartile range 42–62; 562/927 [61%] male; 390/927 [42%] acute myeloid leukemia; 297/927 [32%] lymphoma) with 211/927 (23%) adverse outcomes were processed. We computed 226 features including patient characteristics, medication, clinical signs, as well as laboratory results describing changes of state and interactions of medical parameters. Feature selection revealed 65 features with an area under the receiver operating characteristic curve (AUC) of 0.75. In the validation data set the optimized model had a sensitivity/specificity of 36% and 99% (AUC: 0.68; misclassification error: 0.12) and positive/negative predictive values of 89% and 88%, respectively. The most important features were albumin, age, and procalcitonin. Conclusion Structured granular medical data and machine learning approaches are an innovative tool that can be used in a retrospective setting for prediction of adverse outcomes in patients with prolonged febrile neutropenia. This study is the first important step toward clinical decision support based on predictive models in high-risk cancer patients. Disclosures All authors: No reported disclosures.
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Menkhotti, Franceses. "New modalities for the treatment of febrile neutropenia." Biomedicine & Pharmacotherapy 52, no. 7-8 (January 1998): 345. http://dx.doi.org/10.1016/s0753-3322(98)80125-x.
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Menichetti, Francesco. "New modalities for the treatment of febrile neutropenia." Biomedicine & Pharmacotherapy 52, no. 7-8 (January 1998): 345. http://dx.doi.org/10.1016/s0753-3322(98)80126-1.
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Goulenok, Tiphaine, and Bruno Fantin. "Antimicrobial Treatment of Febrile Neutropenia: Pharmacokinetic–Pharmacodynamic Considerations." Clinical Pharmacokinetics 52, no. 10 (June 27, 2013): 869–83. http://dx.doi.org/10.1007/s40262-013-0086-1.
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Bal, Abhijit M., and Ian M. Gould. "Empirical antimicrobial treatment for chemotherapy-induced febrile neutropenia." International Journal of Antimicrobial Agents 29, no. 5 (May 2007): 501–9. http://dx.doi.org/10.1016/j.ijantimicag.2006.11.026.
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Kim, Byung Soo, Chul Won Choi, and Seok Jin Kim. "The Prognostic Factor Evaluation of Febrile Neutropenia Before Chemotherapy to Hematologic Malignancies." Blood 112, no. 11 (November 16, 2008): 4842. http://dx.doi.org/10.1182/blood.v112.11.4842.4842.
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Abstract Purpose Febrile neutropenia is one of the major toxicities-associated with chemotherapy especially in hematologic disorders. Thus, the occurrence of febrile neutropenia significantly can affect their treatment outcomes. But, it is difficult to predict their clinical courses and treatment outcomes. In this study, we analyzed the prechemothepeutic clinical characteristics of febrile neutropenia and their relationship with the prognosis of febrile neutropenia in the patients with hematologic malignancies. Methods We retrospectively analyzed 259 cases of febrile neutropenia developed after the chemotherapy for their hematologic malignacies from January 2006 to July 2008 at the Korea University Medical Center to identify the potential prognosis predicting factors. For the early detection of the high risk of febrile neutropenia, we focused on the findings before chemotherapy. Results With univariate analysis, age, underlying disease, recovery of neutropenia, onset time of febrile neutropenia, onset location, the duration of fever, infection sites, and type of cultured organism were significantly associated with mortality (p < 0.05). Also, the risk of mortality was significantly associated with laboratory findings (hemoglobin, platelet count, BUN, AST, albumin, sodium, bicarbonate, PT, ESR, CRP) of prechemotherapy. In multivariate analysis, only three variables of laboratory findings were associated with poor outcomes: albumin, bicarbonate and C-reactive protein of prechemotherapy. The recoveries of neutropenia and respiratory tract infection were also the significant risk factors in multivariate analysis. The complication rate in the patients who had three poor variables (low albumin & bicarbonate level and high CRP level) was 82.8%, while in the patient who had no poor variables was only 5.7%. Conclusion The levels of albumin, bicarbonate and CRP, in prechemotherapic condition were associated with the prognosis of febrile neutropenia in our study. Therefore, the further prospective studies will be warranted to confirm the result of this study.
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Sebastian, Prasoon, Abdul Majeed Kuruvadangal, and Hitha Babu. "Incidence of neutropenic fever and sepsis in patients receiving induction chemotherapy in acute leukemia." International Journal of Research in Medical Sciences 9, no. 11 (October 28, 2021): 3335. http://dx.doi.org/10.18203/2320-6012.ijrms20214413.
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Background: Acute leukemias are treated with intensive chemotherapy protocols which are associated with increased risk of infections. The objective of this study was to determine the incidence of febrile neutropenia and sepsis in acute leukemia patients during induction chemotherapy.Methods: In this prospective study we analysed the data of febrile neutropenia of forty-four patients of acute leukemia treated with intensive chemotherapy protocols. Study was conducted in hemato-oncology unit of Government Medical College, Kozhikode from January 2018 to December 2018. Events of the first month of induction were assessed, data entered in Microsoft excel and analysed with SPSS software.Results: Febrile neutropenia developed in all patients with AML induction therapy and 21.4% patients with ALL induction therapy. Causative organism was identified in 41.6% of febrile neutropenia episodes. Major focus of infection was lower respiratory tract followed by gastrointestinal tract. Fungal infection was identified in 6.8% cases. Mortality in AML induction was 31% and that of ALL induction was 3.57%. Infection was the most common cause of mortality. No clinical or laboratory parameters were found significant to predict outcome during induction chemotherapy in acute leukemia.Conclusions: Neutropenic fever and sepsis are the major cause of mortality in acute leukemia during induction chemotherapy. Early initiation of appropriate antibiotics will help to improve outcome in the treatment of leukemia.
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Babicheva, L. G., and S. O. Podvyaznikov. "Prevention of neutropenia as an important factor in successful chemotherapy for head and neck cancer." Head and Neck Tumors (HNT) 11, no. 3 (November 12, 2021): 72–82. http://dx.doi.org/10.17650/2222-1468-2021-11-3-72-82.
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Despite the advances in supportive care for cancer patients, they often develop such a serious complication of chemotherapy as febrile neutropenia. This disorder is the main cause of reduced treatment efficacy because of the lower doses of cytostatics or even withdrawal of myelosuppressive therapy in some cases. The mortality rate from infectious complications of febrile neutropenia currently reaches 10 %.Presence of risk factors in combination with aggressive chemotherapy necessitates prevention of febrile neutropenia to reduce potential risks of complications. Synthetic granulocyte colony-stimulating factors can be used to address this issue.Among patients with head and neck tumors, the most vulnerable population includes individuals receiving TPF or DCF regimen or chemoradiotherapy. Such patients require preventive administration of granulocyte colony-stimulating factors. Patients with grade III–IV neutropenia require prevention of febrile neutropenia with pegylated forms of granulocyte colony-stimulating factors (such as empegfilgrastim). This will ensure optimal treatment outcomes.
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Ranuhardy, Dody. "The Role of Febrile Neutropenia Guideline’s Implementation on Mortality Rate in Dharmais Hospital-National Cancer Center." Indonesian Journal of Cancer 12, no. 3 (January 1, 2019): 71. http://dx.doi.org/10.33371/ijoc.v12i3.612.
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Introduction: Febrile neutropenia have a high morbidity and mortality impact for the patient. The mortality rate of febrile neutropenia in 2002 was 38.8%, while it was 27.3% in 2009. The difference in mortality rates could be caused by several factors such as availability of the Neutropenic Fever Management Guidelines in 2006, in addition to infrastructure, human resources and equipment. This study aims to determine the role of guideline availibility and other factors to cancer mortality rate in the immunocompromised isolation room of Dharmais Hospital. Methods: This study was a cross-sectional retrospective study which investigate mortality rates and compare with adherence to febrile neutropenia guidelines for the period 2008-2012. Data were taken from the patient's medical record file, and then analysed using univariate and bivariate analysis. Results: The mortality rate in the period 2008-2012 was 20.7%. The correlation between age, sex, and degree of risk factor on mortality was not significantly different (p=0,409, p=0,404, and p=0,324). The proportion of deaths was higher in patients borne by third parties (26.8%) than in the case of personal (10%) although not statistically significant (p=0,065). From the three types of adherence, only one had a significant effect of adherence to treatment flow (p=0,033). Conclusions: The availibility of management guideline can reduce mortality rate of febrile neutropenia even though from the three types of adherence, only one had a significant effect of adherence to treatment flow (p=0,033).
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BUDIANA, I. NYOMAN GEDE, and MELINDA FEBIANI. "Febrile Neutropenia pada Pasien Pascakemoterapi." Indonesian Journal of Cancer 11, no. 2 (October 11, 2017): 77. http://dx.doi.org/10.33371/ijoc.v11i2.505.
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ABSTRACTFebrile neutropenia (FN) is one of the side effects caused by chemotherapy due to hematopoetic suppression that cause neutropenia and other triggerring factors such as infection. More specifically, FN is defined as the temperature above 38,3oC at once oral temperature measurements or 38,0oC temperature within a period of time more than one hour with neutrophil counts less than 500/mm3 or neutrophil counts less than 1000/mm3 with predicted decline to 500/ mm3 within 48 hours. Febrile neutropenia defined as a medical emergency and oncology which has a high mortality rate. Although currently there is a great development in the prevention and therapy of FN, but this is still the most feared complication of cancer chemotherapy. This article summarizes the important aspects of the FN as well as it’s early detection and management that should be of concern for clinicians who decide to use chemotherapy as one of treatment modality for their patients. ABSTRAKFebrile neutropenia (FN) merupakan salah satu efek samping dari kemoterapi yang disebabkan oleh supresi hematopoesis yang menyebabkan neutropenia ditambah dengan faktor pencetus lain seperti infeksi. Secara lebih spesifik, FN didefinisikan sebagai temperatur di atas 38,3oC pada sekali pengukuran suhu oral atau suhu 38,0oC dalam jangka waktu lebih dari 1 jam dengan hitung jenis neutrofil kurang dari 500/mm3 atau hitung jenis neutrofil kurang dari 1000/mm3 dengan prediksi terjadi penurunan sampai 500/mm3 dalam waktu 48 jam. Febrile neutropenia ditetapkan sebagai kegawatdaruratan medis dan onkologi yang memiliki angka mortalitas tinggi. Walaupun saat ini terdapat perkembangan besar pada prevensi dan terapi FN, FN masih merupakan komplikasi yang paling ditakuti. Artikel ini merangkum aspek-aspek penting dalam deteksi dan penatalaksanaan FN, di mana hal ini perlu menjadi perhatian klinisi yang memutuskan untuk menggunakan kemoterapi sebagai modalitas pengobatan pasien.
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Diorio, Caroline, Julia Martino, Katherine Mary Boydell, Marie-Chantal Ethier, Chris Mayo, Richard Wing, Oliver Teuffel, Lillian Sung, and Deborah Tomlinson. "Parental Perspectives on Inpatient Versus Outpatient Management of Pediatric Febrile Neutropenia." Journal of Pediatric Oncology Nursing 28, no. 6 (November 2011): 355–62. http://dx.doi.org/10.1177/1043454211418665.
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To describe parent preference for treatment of febrile neutropenia and the key drivers of parental decision making, structured face-to-face interviews were used to elicit parent preferences for inpatient versus outpatient management of pediatric febrile neutropenia. Parents were presented with 4 different scenarios and asked to indicate which treatment option they preferred and to describe reasons for this preference during the face-to-face interview. Comments were recorded in writing by research assistants. A consensus approach to thematic analysis was used to identify themes from the written comments of the research assistants. A total of 155 parents participated in the study. Of these, 80 (51.6%) parents identified hospital-based intravenous treatment as the most preferred treatment scenario for febrile neutropenia. The major themes identified included convenience/disruptiveness, physical health, emotional well-being, and modifiers of parental decision making. Most parents preferred hospital-based treatment for febrile neutropenia. An understanding of issues that influence parental decision making may assist health care workers in planning program implementation and further support families in their decision-making process.
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Bond, T. Christopher, Erika Szabo, Susan Gabriel, Jean Klastersky, Omar Tomey, Udo Mueller, Lee Schwartzberg, and Boxiong Tang. "Meta-analysis and indirect treatment comparison of lipegfilgrastim with pegfilgrastim and filgrastim for the reduction of chemotherapy-induced neutropenia-related events." Journal of Oncology Pharmacy Practice 24, no. 6 (June 14, 2017): 412–23. http://dx.doi.org/10.1177/1078155217714859.
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Background Granulocyte colony-stimulating factors are effective at reducing the risk and duration of neutropenia. The current meta-analysis compared the neutropenia-related efficacy and safety of lipegfilgrastim to those of pegfilgrastim and filgrastim. Methods Embase was searched for trials examining the efficacy/safety of lipegfilgrastim, pegfilgrastim, or filgrastim. Outcomes included febrile neutropenia, severe neutropenia, duration of severe neutropenia, time to recovery of absolute neutrophil count, and incidence of bone pain. Direct comparisons were made using random-effects models. No trials directly compared lipegfilgrastim and filgrastim. Indirect comparisons were made between lipegfilgrastim and filgrastim with pegfilgrastim as the common comparator. Results This meta-analysis included a total of 5769 patients from 24 studies. Over all cycles, lipegfilgrastim showed a lower, nonsignificant risk of febrile neutropenia compared with pegfilgrastim. Lipegfilgrastim has a lower risk of febrile neutropenia versus filgrastim but was also not statistically significant. The risk ratio for severe neutropenia in cycle 1 was 0.80, a 20% reduction in favor of lipegfilgrastim. For cycles 2–4, the risk ratio was 0.53 (0.35, 0.79) for lipegfilgrastim versus pegfilgrastim. The risk of severe neutropenia in cycles 2–4 was also significantly lower for lipegfilgrastim (risk ratio 0.45, 0.27, 0.75, respectively). No significant differences were found for febrile neutropenia and severe neutropenia in cycle 1. However, in cycles 2–4, lipegfilgrastim was associated with significant and clinically meaningful reductions in risk of severe neutropenia versus either pegfilgrastim or filgrastim. Conclusions Compared with pegfilgrastim or filgrastim, lipegfilgrastim has a statistically significantly lower absolute neutrophil count recovery time; however, differences in duration of severe neutropenia and bone pain were nonsignificant.
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Moore, Donald C., Tsion Gebru, Annie Pellegrino, Adenike Fasan, Jolly Patel, and J. Tanner Ringley. "Neutropenia-Associated Outcomes in Patients With Breast Cancer Receiving Myelosuppressive Chemotherapy With Reduced Doses of Pegfilgrastim." Journal of Pharmacy Practice 33, no. 6 (March 27, 2019): 779–83. http://dx.doi.org/10.1177/0897190019838374.
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Background: Pegfilgrastim can be utilized to prevent neutropenia-associated complications in patients receiving myelosuppressive chemotherapy for breast cancer. A common adverse event associated with pegfilgrastim is bone pain. Clinicians may opt to reduce the dose of pegfilgrastim when administering it to patients with previous severe or refractory bone pain. There is limited and conflicting evidence with regard to the safety and efficacy of this practice. The purpose of this study was to investigate the impact of administering reduced doses of pegfilgrastim on neutropenia-associated outcomes in patients with breast cancer receiving myelosuppressive chemotherapy. Methods: A retrospective chart review was conducted at a large, multistate health system with several different medical oncology practice sites. The primary outcome was the incidence of febrile neutropenia. Secondary outcomes included the incidence and severity of neutropenia, hospitalization for febrile, use of intravenous antimicrobials for febrile, delays in chemotherapy or dose reductions in chemotherapy secondary to neutropenia or febrile, rationale for dose reduction of pegfilgrastim, and improvement in bone pain. Results: A total of 80 patients received reduced dose pegfilgrastim. Most patients had their doses reduced secondary to bone pain (54%) or leukocytosis (14%). One (1.25%) patient experienced febrile neutropenia that did not require hospitalization or intravenous antimicrobials. Chemotherapy treatment delays and dose reductions secondary to neutropenia or febrile neutropenia occurred in 1 (1.25%) and 2 (2.5%) patients, respectively. Conclusion: Reduced doses of pegfilgrastim in patients receiving myelosuppressive chemotherapy for breast cancer resulted in a low incidence of neutropenia-associated events, including febrile neutropenia and grade 3/4 neutropenia.
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Hansen, Bent-Are, Øystein Wendelbo, Øyvind Bruserud, Anette Lodvir Hemsing, Knut Anders Mosevoll, and Håkon Reikvam. "FEBRILE NEUTROPENIA IN ACUTE LEUKEMIA. EPIDEMIOLOGY, ETIOLOGY, PATHOPHYSIOLOGY AND TREATMENT." Mediterranean Journal of Hematology and Infectious Diseases 12, no. 1 (December 30, 2019): e2020009. http://dx.doi.org/10.4084/mjhid.2020.009.
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Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. Here, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.
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Tralongo, Antonino C., Andrea Antonuzzo, Paolo Pronzato, Andrea Sbrana, Marianna Turrini, Federica Zoratto, and Marco Danova. "Management of chemotherapy-induced neutropenia in patients with cancer: 2019 guidelines of the Italian Medical Oncology Association (AIOM)." Tumori Journal 106, no. 4 (June 15, 2020): 273–80. http://dx.doi.org/10.1177/0300891620927093.
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Neutropenia is the most frequent side effect of commercially available myelosuppressive drugs and its most significant complication is febrile neutropenia. It is associated with increased hospital admissions and higher probability of death. Prophylaxis with the administration of granulocyte colony-stimulating factor can prevent neutropenia caused by anticancer drugs. The correct administration of these drugs and the management of febrile neutropenia are extremely important in the treatment of patients with cancer.
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Chui, Hayton, Jillian Caldwell, Mariya Yordanova, Vedran Cockovski, Daniel Fredric, Maya Harel-Sterling, Maya Haasz, et al. "Tubular injury and cell-cycle arrest biomarkers to predict acute kidney injury in noncritically ill children receiving aminoglycosides." Biomarkers in Medicine 14, no. 10 (July 2020): 879–94. http://dx.doi.org/10.2217/bmm-2019-0419.
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Aim: NGAL, IL-18, KIM-1 as well as urinary TIMP2 and IGFBP7 and their mathematical product (TIMP2*IGFBP7) were evaluated for detecting pediatric aminoglycoside acute kidney injury (AG-AKI). Methods: In a prospective study, noncritically ill children received aminoglycosides (AG) ≥3 days. The area under the curve (AUC) for biomarkers to detect AKI was calculated by a) days before AKI onset; b) treatment days. Results: There were 113 AG episodes (68% febrile neutropenia). The AKI group had a higher proportion with febrile neutropenia. The AKI group had significantly lower NGAL 3 days before AKI, as patients with febrile neutropenia had a lower NGAL during AG treatment (p < 0.05). NGAL, IL-18 and TIMP2*IGFBP7 had AUC ≥0.73 at 3, 2 and 2 days before AKI onset. Conclusion: NGAL, IL-18 and TIMP2*IGFBP7 were modest early biomarkers of AG-AKI. Febrile neutropenia was associated with lower NGAL.
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Ravaud, A., C. Chevreau, L. Cany, P. Houyau, N. Dohollou, H. Roché, P. Soubeyran, et al. "Granulocyte-macrophage colony-stimulating factor in patients with neutropenic fever is potent after low-risk but not after high-risk neutropenic chemotherapy regimens: results of a randomized phase III trial." Journal of Clinical Oncology 16, no. 9 (September 1998): 2930–36. http://dx.doi.org/10.1200/jco.1998.16.9.2930.
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PURPOSE A randomized unblinded phase III trial was designed to determine the ability of granulocyte-macrophage colony-stimulating factor (GM-CSF) to accelerate recovery from febrile neutropenia induced by chemotherapy. PATIENTS AND METHODS A total of 68 patients with febrile neutropenia following chemotherapy defined as axillary temperature greater than 38 degrees C and absolute neutrophil count (ANC) less than 1 x 10(9)/L were included. After stratification for high- and low-risk chemotherapy to induce febrile neutropenia, treatment was randomized between GM-CSF at 5 microg/kg/d or control, both being associated with antibiotics. RESULTS GM-CSF significantly reduced the median duration of neutropenia from 6 to 3 days for ANC less than 1 x 10(9)/L(P < .001) and from 4 to 3 days for ANC less than 0.5 x 10(9)/L (P=.024), days of hospitalization required for febrile neutropenia, and duration of antibiotics during hospitalization. The greatest benefit with GM-CSF appeared for patients who had received low-risk chemotherapy, for which the median duration of ANC less than 1 x 10(9)/L was reduced from 7 to 2.5 days (P < .001) and from 4 to 2 days for ANC less than 0.5 x 10(9)/L (P=.0011), the duration of hospitalization during the study from 7 to 4 days (P=.003), and the duration on antibiotics during hospitalization from 7 to 3.5 days (P < .001). A multivariate analysis, using Cox regression, showed that variables predictive for recovery from neutropenia were GM-CSF (P=.0010) and time interval between the first day of chemotherapy and randomization (P=.030). There was no benefit for GM-CSF when high-risk chemotherapy was considered. CONCLUSION GM-CSF significantly shortened duration of neutropenia, duration of neutropenic fever-related hospitalization, and duration on antibiotics during hospitalization when febrile neutropenia occurred after low-risk chemotherapy, but not high-risk chemotherapy.
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Santolaya, María E., Ana M. Alvarez, Carmen L. Avilés, Ana Becker, José Cofré, Miguel A. Cumsille, Miguel L. O'Ryan, et al. "Early Hospital Discharge Followed by Outpatient Management Versus Continued Hospitalization of Children With Cancer, Fever, and Neutropenia at Low Risk for Invasive Bacterial Infection." Journal of Clinical Oncology 22, no. 18 (September 15, 2004): 3784–89. http://dx.doi.org/10.1200/jco.2004.01.078.
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Purpose To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI). Patients and Methods Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and cost were determined for each episode and compared between both groups using predefined definitions and questionnaires. Results A total of 161 (41%) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk, of which 149 were randomly assigned to ambulatory (n = 78) or hospital-based (n = 71) treatment. In both groups, mean age (ambulatory management, 55 months; hospital-based management, 66 months), sex, and type of cancer were similar. Outcome was favorable in 74 (95%) of 78 ambulatory-treated children and 67 (94%) of 71 hospital-treated children (P = NS). Mean cost of an episode was US $638 (95% CI, $572 to $703) and US $903 (95% CI, $781 to $1,025) for the ambulatory and hospital-based groups, respectively (P = .003). Conclusion For children with febrile neutropenia at low risk for IBI, ambulatory management is safe and significantly cost saving compared with standard hospitalized therapy.
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Chohan, K., D. Lai, M. McNamara, L. Grogan, and O. S. Breathnach. "The frequency of febrile neutropenia in oncology patients receiving chemotherapy." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20691-e20691. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20691.
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e20691 Background:Febrile neutropenia (F/N) is a relatively common and serious side effect for oncology patients undergoing chemotherapy. Due to varying dosages and frequency of cytotoxic agents administered to oncology patients, the incidence and grade of neutropenia varies. The purpose of this study was to establish the frequency of febrile neutropenia in different chemotherapy regimens. Methods: Data was collected on 343 patients who underwent chemotherapy over a 9 month period. Regimens that caused at least one episode of febrile neutropenia in patients within that period were assessed in the study. A list of the patients on identified chemotherapy regimens during the time period was generated by the pharmacy department. Data on patients who had febrile neutropenia was obtained from their clinical notes. Clinical data was then obtained on all those patients. This information was then used to compare the frequency of febrile neutropenia in the included chemotherapy regimens. Results: 343 patients were included in this study. Of those, 41 patients developed febrile neutropenia within the 9 month period (11%); there were 49 cases of febrile neutropenia (14%) in total as some patients had more than one episode. Conclusions: Febrile neutropenia (FN) is a known potential side-effect from treatment with chemotherapy. This study highlights the rates of FN in patients treated within one centre. In patients being treated with specific chemotherapy regimens this study may guide the increased use of G-CSF and better outline the risk profile of such therapy to patients. [Table: see text] No significant financial relationships to disclose.
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Pappu, Dr Finciya C., Dr Helna Shaji, Dr Steffi Bennis, Dr Soumya Mary Alex, and Dr C. S. Madhu. "A Study to Assess the Management of Febrile Neutropenia in Oncology Patients in a Tertiary Care Hospital." Saudi Journal of Medical and Pharmaceutical Sciences 8, no. 7 (July 15, 2022): 343–54. http://dx.doi.org/10.36348/sjmps.2022.v08i07.005.
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Background: The cytotoxic chemotherapy is the mainstay treatment of cancer and it is usually complicated with infections. Appropriate antibiotics and other supportive medications must be started immediately as bacterial infections may progress with the absence of granulocytes. Improved outcomes can be seen with empirical administration of broad-spectrum antibiotics and they remain as the standard of care. Patients with intermediate-risk for Febrile Nuetropenia (FN) (10%-20%) need to be evaluated for additional patient risk factors, after assessment, patients who present with at least one of the risk factors for FN is recommended for treatment with a G-CSF. Methodology: Our study was a retrospective cohort single centered observational study carried out randomly in 104 patients in the oncology department of Lourdes hospital, Cochin Data of the patients were collected from Mediware system, medical records and Statistical software SPSS were used for analysis of the data. Results: In our study febrile neutropenia was managed using antimicrobials, of which antibiotics and antifungals prescribed were 12.09% and 1.97% respectively and with granulocyte-colony stimulating factors (G-CSFs) (6.15%). Principally used empirical monotherapy was meropenem sulbactum / meropenem (n = 48) which was followed by piperacillin tazobactum (n=18) and cefoperazone sulbactum (n=15) This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The compliance with National Comprehensive Cancer Network (NCCN) guidelines were analyzed in that we can see 84.6% patients had partial compliance and 14.4% patients had full compliance. Conclusion: A total of 66 patients received both antibiotics and G-CSF treatment however 13 patients and 25 patients were managed only with G-CSF and antibiotic therapy respectively. This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. These regimens were used mainly in breast cancer patients. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The NCCN guidelines, majority of patients showed partial compliance(86.6%) and about (14.4%) showed full compliance.
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Chand, Vikram K., Justine Ritchie, Mary Shannon, Brian K. Link, and James E. Wooldridge. "Incidence of Febrile Neutropenia Is Low and Unrelated to Day 1 Neutrophil Count in Hodgkin’s Lymphoma Treated with ABVD." Blood 104, no. 11 (November 16, 2004): 4590. http://dx.doi.org/10.1182/blood.v104.11.4590.4590.
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Abstract BACKGROUND: When neutropenia without infection is encountered while treating Hodgkin’s Lymphoma (HL) with ABVD chemotherapy clinicians may choose to delay or reduce the chemotherapy dose or maintain the dose intensity and schedule with or without neutrophil growth factor support out of concern for neutropenic complications. We sought to determine the frequency of neutropenia and febrile neutropenia (FN) during ABVD chemotherapy. METHODS: We examined the medical records of all patients seen at Univ. of Iowa diagnosed with HL between 1/1/1990 and 12/31/2002 treated with ABVD chemotherapy. We reviewed the charts with complete chemotherapy dosing records to determine the incidence of neutropenia, dose reduction, dose delay and chart record of febrile neutropenia (FN). RESULTS: 218 patients were seen at UIHC with the diagnosis of HL. 104 patients were treated with ABVD chemotherapy. Adequate dosing data was available for 82 of these patients (894 treatments). On scheduled day of treatment (Day 1 and 15 of each cycle) at least Grade III neutropenia (ANC<1000) was present in 51 pts and 165 (18.45%) treatments. Grade IV (ANC<500) neutropenia was present in 28 pts and 56 (6.26%) treatments. Grade III/IV neutropenia was most frequent at treatment 2 (C1, D15) (n=32). Figure 1 illustrates the frequency of Grade III/IV neutropenia on day 1 of treatment. Dose modification (DM) defined as dose delay of > 4 days and/or dose reduction to < 80% of original doxorubicin dose following neutropenia occurred at only 10 of 165 treatments. No episodes of FN developed in this cohort. 155 treatments at the time of neutropenia were administered without dose reduction or dose delay. Growth factor support was co-administered in 55 (36.77%) of these treatments and the remaining treatments at the time of neutropenia (73.23%, n=100) were administered without growth factor support. One episode of FN developed in each of these subsets. No FN was observed following the 56 treatments administered with an ANC < 500, including 54 managed without DM (32 with GCSF support and 22 without). 672 treatments were administered with ANC ≥ 1000 resulting in 6 episodes of FN. DM was observed in 78 of these 672 treatments with 3 subsequent episodes of FN. 57 treatments (4 with DM, 23 with GCSF, 20 without GCSF, 14 unknown GCSF) had no available ANC data and were associated with one episode of FN. FN developed a total of 9 times in 8 of 82 patients over 894 treatments. CONCLUSION: Among HL patients treated with ABVD chemotherapy we found a high frequency of neutropenia - most commonly following treatment 1. We found a very low incidence of FN that was independent of neutropenia at the time of chemotherapy administration. Dose modification for neutropenia without infection at the time of ABVD administration is not required to reduce risk of FN, and should be avoided in settings where maintaining dose intensity is considered valuable.
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Unal, A., A. Birekul, L. Kaynar, B. Eser, and M. Cetin. "Successful Treatment With Granulocyte Transfusion and Early Neutrophil Engraftment in Allogeneic Transplant Patients With Febrile Neutropenia: Does Granulocyte Transfusion Effect on Neutrophil Engraftment?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 225s. http://dx.doi.org/10.1200/jgo.18.91100.
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Background: Febrile neutropenia is very severe and urgent early complication after bone marrow transplantation before engraftment. Infection delays engraftments in these periods. Aim: In this study we evaluated the effect and outcome of granulocyte transfusion on febrile neutropenia and neutrophil engraftment in patients receiving allogeneic transplantation. The reasons for the use of the granulocyte transfusion were prolonged febrile neutropenia episode. Methods: Between 2015-2017, 16 patients receiving allogeneic bone marrow transplantation (BMT) were treated with granulocyte transfusion at the time of febrile neutropenia before engraftment. Sixteen patients (9 AML, and 7 ALL) underwent allogeneic transplantation. Nine of them transplanted from match sibling donors, 1 from unrelated donor, and 6 from mismatch family donor (haploidentic transplantation). They had febrile neutropenia after transplantation, before engraftment. They were given antimicrobial therapy. Granulocyte was collected from unrelated and same blood groups donors. We started granulocyte transfusion for 3-4 days. Results: Mean infused granulocyte counts were 3 × 1010 (1.2-4.8 × 1010)/d, and about 15%-20% of transfused granulocyte was monocyte. Before the granulocyte transfusion, on the 12th to 19th days of transplantation, their neutrophil counts were 0.02-0.09 × 103/dL. Twenty-four hours after granulocyte transfusion, mean neutrophil counts were 0.7 × 103/dL (0.4-1.2 × 103/dL). Neutrophil counts were 2.2 × 103/dL (1.7-2.6 × 103/dL) after 48 hour. After 72 hours, neutrophil counts were 3.2 × 103/dL (2.0- 4.6 × 103/dL). After 4th days of granulocyte transfusion, neutrophil counts were normal level (>0.5 × 103/dL) in 12 patients, and less than normal level (<0.5 × 103/dL) in 4 patients. Conclusion: Granulocyte transfusions during the febrile neutropenia, helped to better overcome febrile neutropenia periods in allogeneic transplant patients before engraftment. In addition, granulocytes transfusion also may help early neutrophil engraftments. The useful effect of granulocyte transfusion on neutrophil engraftment may be cause of cytokine (G-CSF) injection to donor before collection of granulocyte. Increased cytokine (G-CSF–GM-CSF–IL-3) level of transfused neutrophil and monocyte can also effect the neutrophil engraftment.
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Murtaza, Hafiz Muhammad, Samra Maryam, Muhammad Shaheen Iqbal, Tariq Ghafoor, Aamir Aslam Awan, and Naeem Farid. "Chemotherapy Induced Neutropenic Fever and Its Response to Empirical Antimicrobial Therapy." Pakistan Armed Forces Medical Journal 72, SUPPL-2 (June 2, 2022): S172–77. http://dx.doi.org/10.51253/pafmj.v72isuppl-2.3079.
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Objective: To find out the frequency of chemotherapy-induced febrile neutropenia (FN) in children diagnosed with Acute Lymphoblastic Leukemia (ALL) and its response to empirical antibiotic therapy.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Peadiatric Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2017 to Oct 2018.
Methodology: Newly diagnosed pediatric patients suffering from acute lymphoblastic leukemia between 1 to 15 years of age were included. All patients were treated with chemotherapy according to the United Kingdom National Randomized Trial for Children and Young adults with Acute Lymphoblastic Leukemia (UKALL) 2011 protocol. Patients with febrile neutropenic (FN) episodes were treated with empirical antimicrobial therapy as per hospital guidelines. Patients ‘response to antimicrobial therapy, blood culture results and related complications were noted.
Results: Out of a total 77 patients, 45 (58.4%) had 69 episodes of febrile neutropenia (FN), 62 (78.5%) episodes of febrile neutropenia (FN) were started empirical treatment with first-line antibiotics (piperacillin-tazobactam and amikacin) whereas 15 (21.7%) episodes of febrile neutropenia (FN) not responding to the 1st line were shifted to second-line antibiotics (meropenem and amikacin). Mean duration of fever was 4.1 ± 2.8 days on 1st line antibiotic regimen, 2.6 ± 1 days on 2nd line antibiotics and 6.3 ± 3.3 days on combination with antifungal drug. Ten patients received antifungal therapy empirically. Efficacy of the 1st line and the 2nd line was 72.5% and 77% respectively. Staphylococcus aureus was the most frequent organism isolated from blood culture results. During the induction phase, 10 (12.9%) patients..............
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Catic, Tarik, Alma MekicAbazovic, and Samra Sulejmanovic. "Cost of Febrile Neutropenia Treatment in Bosnia and Herzegovina." Materia Socio Medica 28, no. 2 (2016): 112. http://dx.doi.org/10.5455/msm.2016.28.112-114.
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