Is antimicrobial prophylaxis necessary for lymphoma patients? A single centre, real-life experience

Abstract

Background Prophylaxis is strongly recommended in patients with hematological malignancy who are usually at higher risk for infection and neutropenic fever. It is still unclear whether or not there is a definite need for antimicrobial prophylaxis in intermediate-risk hematology patients such as those with lymphoma. Methods A retrospective analysis was made of patients admitted from January 2009 to December 2017 to the Hematology Department of Diskapi Yildirim Beyazit Training and Research Hospital, a tertiary referral hospital in Ankara, Turkey. The study included patients who were diagnosed with any type of lymphoma and given chemotherapy. Routine antimicrobial prophylaxis was administered to 127 lymphoma patients, and not to 65 lymphoma patients. These two groups were compared in respect of the incidence of total infection episodes (IE), febrile neutropenia episodes, and nonneutropenic clinically documented infection episodes. Results For all patients with lymphoma and subtypes of non-Hodgkin lymphoma or Hodgkin lymphoma, no significant difference was determined between the groups in respect of the total incidence of IE, febrile neutropenia and nonneutropenic clinically documented infection both during the first-line chemotherapy and throughout the total follow-up period ( p > 0.05). Patients with prophylaxis had a higher incidence of IE, which was treated with parenteral antibiotics both during the first-line chemotherapy and throughout the total follow-up period ( p < 0.05). Conclusion Antimicrobial prophylaxis was seen to have no effect on the total incidence of infection episode and febrile neutropenia. Therefore, the routine use of antimicrobial prophylaxis should not be recommended for patients with lymphoma.

How I manage infection risk and prevention in patients with lymphoid cancer

“…Emerging data suggest that routine use of antimicrobial prophylaxis may not be required for patients with lymphoma. 8,9 International guidelines recommend the use of prophylactic granulocyte colony-stimulating factor for mitigating chemotherapy-induced neutropenia when using a regimen associated with FN in .20% patients, when dosedense or dose-intense chemotherapy strategies have survival benefits, or if reductions in dose intensity or density are known to be associated with a poor prognosis. [10][11][12][13] Antiviral prophylaxis against herpesviruses is recommended in certain situations.…”

Hematopoietic stem cell transplantation does not increase the risk of infection‐related complications for pediatric patients with Hodgkin and non‐Hodgkin lymphomas: A multicenter nationwide study

“…These may include the underlying malignancy, immunosuppression, nonspecific clinical presentation that may delay diagnosis and treatment of IC, antimicrobial prophylaxis, and timing of anti‐infective therapy in all lymphoma patients and additionally myeloablation along with immunosuppression related to both conditioning regimen and prevention and/or treatment of graft‐versus‐host disease (GvHD) in those who have undergone transplantation, especially from an unrelated donor. In consequence, infections may cause significant morbidity in lymphoma patients 3 . Patients with severe infections, especially bacterial or fungal ones, have to receive weeks to months of medical and/or surgical treatment and may experience long‐term morbidities even if their antibacterial or antifungal therapies are successful.…”

“…In consequence, infections may cause significant morbidity in lymphoma patients. 3 Patients with severe infections, especially bacterial or fungal ones, have to receive weeks to months of medical and/or surgical treatment and may experience long-term morbidities even if their antibacterial or antifungal therapies are successful.…”