Persistent Fever After Recovery From Granulocytopenia in Acute Leukemia

Talbot, George H.; Provencher, Mary; Cassileth, Peter A.

doi:10.1001/archinte.1988.00380010131013

Cited by 33 publications

(12 citation statements)

References 43 publications

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“…Approximately two thirds of treatment-associated deaths are caused by infections [6]. The micro-organisms that are most frequent causes of infection after chemotherapy are fungi such as Aspergillus sp., aerobic gram-negative bacilli, especially E. coli, Klebsiella sp., Enterobacter sp., Serratia sp., Proteus sp., P. aeroginosa; and gram-positive bacteria, such as Staphylococcus aureus, Staphylococcus epidermitis, and Streptococcus viridans [11,13]. These findings are comparable to the results in our cohort.…”

Section: Discussionsupporting

confidence: 90%

Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia

Hübel

Hegener

Schnell

et al. 1999

Annals of Hematology

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Severe infections are a major problem in patients suffering from acute nonlymphocytic leukemia (ANLL) undergoing myeloablative chemotherapy. Possible factors leading to infectious complications in these patients are suppressed immune defense mechanisms existing prior to therapy, including those involving the neutrophil granulocyte department. In this study we investigated whether neutrophil function as measured by oxidative burst and phagocytosis before the start of treatment correlates with the severity of infection after therapy. Forty-four patients were included, 27 men and 17 women. Their median age was 46 years (range 20-70 years). According to the development of infectious complications the patients were assigned retrospectively to group 1 (no or only mild infections, n = 29) or to group 2 (severe infection or death due to infection, n = 15). The phagocytic activity was significantly reduced in group 2 as compared with group 1 [113.7+/-13.7 (SEM) vs 170.0+/-19.2, mean channel fluorescence; p =0.04]. In contrast, the oxidative burst as measured by FMLP stimulation was pronounced but not significantly enhanced in group 2 (24.8+/-6.1 vs 14.5+/-3.4, mean channel fluorescence). In conclusion, patients with severe infections after chemotherapy might already have preactivated neutrophils with suppressed function prior to treatment. Thus, evaluating function parameters could help to estimate the individual risk of infection for a patient with ANLL.

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Section: Discussionsupporting

confidence: 90%

Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia

Hübel

Hegener

Schnell

et al. 1999

Annals of Hematology

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“…If the fever persists after the resolution of neutropenia (i.e., Ͼ 500 cells/ mL), then the patient should be reassessed for cryptic bacterial, fungal, or viral infections. 88 If no infection is documented, then treatment can be discontinued 5 days after the resolution of neutropenia despite the presence of persistent fever.…”

Section: Persistent Fever After 3-5 Days Of Empirical Antibiotic Treamentioning

confidence: 99%

Perspectives for the management of febrile neutropenic patients with cancer in the 21st century

Sipsas

Bodey

Kontoyiannis

2005

Cancer

140

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Over the past several decades, there has been substantial progress in the management of patients with febrile neutropenia. However, the ever-changing patterns of infection, ecology, and antibiotic-resistance trends do not allow the development of treatment guidelines that could be applied universally. Hence, the institution's predominant pathogens and resistance patterns should guide the empirical choice of antimicrobials. Prompt initiation of antimicrobial therapy remains the gold standard. Monotherapy with the newer broad-spectrum antimicrobials has tended to replace the classic combination therapy. Empirical administration of glycopeptides, such as vancomycin, without documentation of a gram-positive infection is not favored. The development of risk-stratification models has allowed for identification of low-risk patients with additional treatment options, such as early discharge and exclusively outpatient treatment with oral antimicrobials. The initiation of empirical antifungal therapy in persistently febrile neutropenic patients has become common practice, especially recently, since the introduction of new, effective, less toxic antifungal drugs. It is hoped that the development of new nonculture-based diagnostic methods will allow for the early detection of invasive fungal infections and, thus, the replacement of empirical antifungal therapy with pathogen-specific, preemptive therapy.

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“…It is believed that the prolonged course of fever observed in these patients is due to immune reconstitution inflammatory syndrome associated with invasive fungal infections, as has been described in patients with human immunodeficiency virus infection or those who have undergone solid organ transplantation, rather than treatment failure. The time for resolution of fever has exceeded 4 weeks in some reports and cumulative data suggest that a median of at least 15 days is required before resolution (2, 5, 16, 31–33). Our patient had continuous fever during the first few weeks of antifungal therapy without any radiographic progression of hepatosplenic abscesses.…”

Section: Discussionmentioning

confidence: 99%

Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature

Poon

Chia

Tan

et al. 2009

Transplant Infectious Dis

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Hepatosplenic candidiasis (HSC) in patients with acute leukemia poses management challenges because the therapeutic limitations of the present antifungal armamentarium may adversely impact on treatment outcomes of the underlying leukemia. We report a patient with acute myeloid leukemia who developed HSC during post-remission consolidation chemotherapy and was treated with a prolonged course of caspofungin followed by fluconazole. The stabilization of infection permitted further chemotherapy and autologous hematopoietic cell transplant (HCT) without breakthrough fungemia and further dissemination of candidiasis. The favorable outcome provides further evidence that with optimal treatment, the presence of stable or non-progressive HSC is not an absolute contraindication for HCT. The use of caspofungin in the primary treatment of HSC appears to be a promising approach. The favorable outcome seen in this case is encouraging, although further study on its efficacy is warranted.

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Persistent Fever After Recovery From Granulocytopenia in Acute Leukemia

Cited by 33 publications

References 43 publications

Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia

Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia

Perspectives for the management of febrile neutropenic patients with cancer in the 21st century

Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature

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