Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

Villafuerte-Gutierrez, Paola; Villalón, Lucı́a; Losa, Juan Emilio; Henriquez-Camacho, Cesar

doi:10.1155/2014/986938

Cited by 60 publications

(49 citation statements)

References 61 publications

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“…65 Invasive fungal infection produced by yeasts and molds is the main infectious cause of death in patients with hematological malignancies; therefore, antifungal prophylaxis is recommended. 66,67 Clinical practice guidelines from the Infectious Diseases Society of America 62 recommend intravenous or oral voriconazole as first-line therapy for invasive pulmonary aspergillosis.…”

Section: Discussionmentioning

confidence: 99%

Marijuana Smoking in Patients with Leukemia

et al. 2016

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Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.

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Section: Discussionmentioning

confidence: 99%

Marijuana Smoking in Patients with Leukemia

et al. 2016

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“…Febrile neutropenia (FN) is a medical emergency, leads to a large number of hospital admissions and contributes to morbidity and mortality in the hematology patient population [3–5]. Fever may represent the only hallmark of blood stream infection (BSI) in the neutropenic patient, with the usual focal symptoms and signs typically attenuated by the absence of functional innate immunity [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection

et al. 2017

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Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a “real world” cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period. In this cohort, the 30-day mortality following confirmed blood stream infection (BSI) was 5.9%, which is lower than most reports in the recent literature. We compared the blood culture results of inpatients undergoing induction chemotherapy and outpatients presenting with fevers and found a significantly higher rate of proven BSI in the outpatient group. In all settings, gram-negative organisms were most common. The rate of resistance to first-line empiric antibiotics among pathogenic isolates was 11.6% in the whole cohort, independent of blood culture circumstances. There was a trend to higher resistance rates among inpatients undergoing induction chemotherapy compared to patients presenting to the emergency department (17.4% vs 7.5%) but this did not reach statistical significance. We also report low rates of ciprofloxacin resistance (5% of isolates), in a center where universal fluoroquinolone prophylaxis is not employed. Our low resistance and mortality rates support our current therapeutic strategies, however presence of resistant organisms across the spectrum of indications for BC collection highlights the importance of surveilling local patterns, escalating antimicrobial therapy in the deteriorating patient, and considering advanced techniques for the rapid identification of resistance in this patient population.

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“…Management of patients with prolonged neutropenia and FN includes: (1) thorough physical evaluation for the site or source of infection, (2) taking enough cultures and septic screens, (3) administration of prophylactic and empirical antimicrobials, and (4) pre-emptive or prophylactic administration of granulocyte-colony stimulating factor (G-CSF) in patients who are expected to have prolonged or severe neutropenia [58,59]. However, the choice of empirical antibiotic therapy in patients with HMs having FN depends on the risk stratification of the individual patient [61,62]. In low-risk (LR) patients with FN, duration of neutropenia is <1 week and there are no comorbid medical conditions; while in high-risk (HR) patients with FN, the duration of neutropenia is >1 week and there are comorbid medical conditions [61,62].…”

Section: Neutropenia and Febrile Neutropeniamentioning

confidence: 99%

“…However, the choice of empirical antibiotic therapy in patients with HMs having FN depends on the risk stratification of the individual patient [61,62]. In low-risk (LR) patients with FN, duration of neutropenia is <1 week and there are no comorbid medical conditions; while in high-risk (HR) patients with FN, the duration of neutropenia is >1 week and there are comorbid medical conditions [61,62]. In case the patient is stratified as LR, oral antibiotics such as ciprofloxacin or levofloxacin are sufficient, while if the patient belongs to the HR group, intravenous (IV) antibiotics may need to be administered.…”

Section: Neutropenia and Febrile Neutropeniamentioning

confidence: 99%

Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Al-Jasser¹,

Al-Anazi²

2019

Update on Multiple Myeloma

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Multiple myeloma is a common hematologic malignancy that is associated with reduced cellular as well as humoral immunity ultimately causing various infectious complications. The recent advances in the management of myeloma have led not only to prolonged survival but also to shifts in the incidence as well as the spectrum of infections encountered. This book chapter will be an updated review on the infectious complications in patients with multiple myeloma in the era of novel agents, stem cell therapies, and monoclonal antibodies. It will cover causes of immunosuppression, timing, and types as well as management of the various infections reported with various therapeutic modalities that are currently utilized in the management of myeloma patients.

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Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

Cited by 60 publications

References 61 publications

Marijuana Smoking in Patients with Leukemia

Marijuana Smoking in Patients with Leukemia

Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection

Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

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