1
|
de la Court JR, Bruns AHW, Roukens AHE, Baas IO, van Steeg K, Toren-Wielema ML, Tersmette M, Blijlevens NMA, Huis In 't Veld RAG, Wolfs TFW, Tissing WJE, Kyuchukova Y, Heijmans J. The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer. Infect Dis Ther 2022; 11:2063-2098. [PMID: 36229765 PMCID: PMC9669256 DOI: 10.1007/s40121-022-00700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and pediatric patients. METHOD The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010-2020) and, where necessary, supplemented by expert-based advice. RESULTS For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients. CONCLUSION This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin-tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended.
Collapse
Affiliation(s)
- J R de la Court
- Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam, The Netherlands
| | - A H W Bruns
- Department of Infectious Diseases, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A H E Roukens
- Department of Infectious Diseases, Leiden University Centre of Infectious Diseases, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - I O Baas
- Department of Medical Oncology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - K van Steeg
- Department of Clinical Pharmacology, ZGT Hospital, University of Groningen, Almelo and Hengelo, The Netherlands
| | - M L Toren-Wielema
- Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M Tersmette
- Department of Medical Microbiology and Immunology, Sint Antonius Hospital, Nieuwegein and Utrecht, The Netherlands
| | - N M A Blijlevens
- Department of Haematology, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - R A G Huis In 't Veld
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - T F W Wolfs
- Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W J E Tissing
- Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pediatric Oncology and Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Y Kyuchukova
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Heijmans
- Department of Haematology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Owattanapanich W, Chayakulkeeree M. Efficacy of levofloxacin as an antibacterial prophylaxis for acute leukemia patients receiving intensive chemotherapy: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 24:362-368. [PMID: 30880638 DOI: 10.1080/16078454.2019.1589706] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The incidence of febrile neutropenia (FN) in acute leukemia patients following induction or consolidation chemotherapy is high. Several clinical practice guidelines recommend the use of a fluoroquinolone prophylaxis to prevent bacterial infection in patients being prone to prolonged profound neutropenia. METHODS This systematic review and meta-analysis aimed to investigate the efficacy and complications of levofloxacin as a prophylaxis for FN patients following chemotherapy for acute leukemia. Two databases from MEDLINE and EMBASE were searched for published studies indexed before 10 July 2018. RESULTS A total of 862 acute leukemia patients were included, with 356 in the levofloxacin prophylaxis arm and 506 in the no-prophylaxis arm. Patients receiving levofloxacin had a significantly lower FN rate than patients who did not receive the antibiotic prophylaxis (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.32-0.58, p < .00001, I2 = 0%). The rate of microbiologically documented infection in the no-prophylaxis group was higher than that for the levofloxacin prophylaxis group (OR: 0.45, 95% CI: 0.34-0.60, p < .00001, I2 = 0%). The bacteremia rate in the levofloxacin prophylaxis group was significantly lower than that for the no-prophylaxis group (OR: 0.45, 95% CI: 0.31-0.66, p < .00001, I2 = 0%). However, the mortality rates of the two groups were quite similar between the two groups (OR: 0.67, 95% CI: 0.34-1.33, p = .26, I2 = 0%). CONCLUSIONS Although the levofloxacin prophylaxis for the acute leukemia patients receiving intensive chemotherapy showed advantages for infectious complications, it did not affect mortality.
Collapse
Affiliation(s)
- Weerapat Owattanapanich
- a Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Methee Chayakulkeeree
- b Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| |
Collapse
|
3
|
Rambaran KA, Seifert CF. Ciprofloxacin vs. levofloxacin for prophylaxis in recipients of hematopoietic stem cell transplantation. J Oncol Pharm Pract 2018; 25:884-890. [DOI: 10.1177/1078155218787286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Infection is the most common cause of morbidity and mortality in patients undergoing myleosuppressive therapy with the risk of infection being heightened during the neutropenic phase. Fluoroquinolones are most often utilized as prophylaxis, specifically levofloxacin or ciprofloxacin; however, there is increasing resistance among these agents. The objective of this study is to compare the efficacy of ciprofloxacin and levofloxacin when used prophylactically in hematopoietic stem cell transplantation patients. Study design A retrospective cohort study conducted at a 443-bed tertiary teaching county hospital from 1 January 2005 to 31 September 2016. Methods Patients aged 18–89 who were admitted and received levofloxacin or ciprofloxacin post hematopoietic stem cell transplantation were evaluated. Results The patient population (N = 151) was predominantly male (93 vs. 58) and the median (IQR) age was 57 (20.1) years. There were 108 patients undergoing autologous hematopoietic stem cell transplantation compared to 43 undergoing allogenic hematopoietic stem cell transplantation. Significantly fewer patients who received levofloxacin (11/43, 25.6%) developed neutropenic fever compared to patients who received ciprofloxacin (61/108, 56.5%, p = 0.0006). Also there were significantly more positive blood cultures in the ciprofloxacin group (36/108, 33.3%) compared to the levofloxacin group (4/43, 9.3%); the majority of which were Gram-positive organisms (p = 0.0025). Conclusion Prophylaxis with levofloxacin was associated with a lower incidence of febrile neutropenia and bacteremia when compared to ciprofloxacin in hematopoietic stem cell transplantation patients.
Collapse
Affiliation(s)
- Kerry Anne Rambaran
- Keck Graduate Institute School of Pharmacy, Claremont, CA, USA
- Texas Tech University Health Sciences Center, School of Pharmacy, Lubbock, TX, USA
| | - Charles F Seifert
- Texas Tech University Health Sciences Center, School of Pharmacy, Lubbock, TX, USA
| |
Collapse
|
4
|
Labiad Y, Venton G, Farnault L, Baier C, Colle J, Mercier C, Ivanov V, Nicolino C, Loriod B, Fernandez-Nunez N, Torres M, Mattei JC, Rihet P, Nguyen C, Costello R. A transcriptomic signature predicting septic outcome in patients undergoing autologous stem cell transplantation. Exp Hematol 2018; 65:49-56. [PMID: 29885947 DOI: 10.1016/j.exphem.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/25/2018] [Accepted: 06/03/2018] [Indexed: 11/26/2022]
Abstract
Autologous hematopoietic stem cell transplantation is the standard treatment for multiple myeloma and relapsed or refractory lymphomas. After autologous hematopoietic stem cell transplantation, hematologic reconstitution and infectious complications are the two most critical issues. Although many patients develop infectious complications after therapeutic intensification, it remains impossible to predict infection for each individual. The goal of this work was to determine and identify a predictive transcriptomic signature of systemic inflammatory response syndrome and/or sepsis in patients receiving autologous hematopoietic stem cell transplantation. High-throughput transcriptomic and bioinformatics analysis were performed to analyze gene expression modulation in peripheral blood mononuclear cells in 21 patients undergoing autologous hematopoietic stem cell transplantation for hematological malignancies (lymphoma or multiple myeloma). Transcriptomic analysis of peripheral blood mononuclear cells samples collected just after conditioning regimen identified an 11-gene signature (CHAT, CNN3, ANKRD42, LOC100505725, EDAR, GPAT2, ENST00000390425, MTRM8, C6orf192, LOC10289230, and XLOC-005643) that was able to early predict (at least 2-7 days before its occurrence) the development of systemic inflammatory response syndrome or sepsis. The possibility of systemic inflammatory response syndrome or sepsis occurrence early prediction (2-7 days before occurrence) opens up new therapeutic strategies based on preemptive antibiotic and/or antifungal prophylaxis adapted to the specific risk profile of each patient.
Collapse
Affiliation(s)
- Yasmine Labiad
- Aix Marseille University, INSERM, TAGC, Marseille, France
| | - Geoffroy Venton
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | - Laure Farnault
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | - Céline Baier
- Aix Marseille University, INSERM, TAGC, Marseille, France
| | - Julien Colle
- Aix Marseille University, INSERM, TAGC, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | - Cédric Mercier
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | - Vadim Ivanov
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | - Corinne Nicolino
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | | | | | - Magali Torres
- Aix Marseille University, INSERM, TAGC, Marseille, France
| | | | - Pascal Rihet
- Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France
| | | | - Régis Costello
- Aix Marseille University, INSERM, TAGC, Marseille, France; Assistance Publique des Hôpitaux de Marseille, Service d'Hématologie et de Thérapie Cellulaire de La Conception, Marseille, France.
| |
Collapse
|
5
|
Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. J Infect 2017; 76:20-37. [PMID: 29079323 DOI: 10.1016/j.jinf.2017.10.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. METHODS Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. RESULTS Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. CONCLUSIONS The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.
Collapse
|
6
|
Wilk CM, Weber I, Seidl K, Rachmühl C, Holzmann-Bürgel A, Müller AMS, Kuster SP, Schanz U, Zinkernagel AS. Impact of oral gut decontamination on Staphylococcus aureus colonisation in patients undergoing allogeneic haematopoietic stem cell transplantation. Int J Antimicrob Agents 2017; 50:726-729. [PMID: 28797807 DOI: 10.1016/j.ijantimicag.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
Abstract
Recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) are severely immunocompromised and are at increased risk of infection. In this prospective, observational, single-centre study including 110 allo-HSCT recipients, the rate of Staphylococcus aureus colonisation was reduced from 11.8% to 0% (P <0.001) following peritransplant oral gut decontamination. No invasive S. aureus infections were observed.
Collapse
Affiliation(s)
- C Matthias Wilk
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabel Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kati Seidl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carole Rachmühl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne Holzmann-Bürgel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonia M S Müller
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Urs Schanz
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
7
|
Chong Y, Shimoda S, Miyake N, Aoki T, Ito Y, Kamimura T, Shimono N. Incomplete recovery of the fecal flora of hematological patients with neutropenia and repeated fluoroquinolone prophylaxis. Infect Drug Resist 2017; 10:193-199. [PMID: 28721078 PMCID: PMC5500534 DOI: 10.2147/idr.s133333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Routine fluoroquinolone prophylaxis in neutropenic patients with hematological malignancies is still controversial, because of antibiotic resistance concerns. The recovery of the fecal microbiota to the initial composition in patients receiving multiple courses of quinolone prophylaxis and repeated chemotherapy has not been evaluated. Methods We prospectively examined the changes in the fecal bacterial composition before and after levofloxacin prophylaxis. A sequential observation of bacterial resistance in patients receiving multiple prophylactic courses was also conducted. Results In this trial, 68 cases, including (35 with the first course and 33 with the second and subsequent courses) were registered. The disappearance of quinolone-susceptible (QS) Entero-bacteriaceae and dominant emergence of quinolone-resistant (QR) coagulase negative staphylococci (CNS) and QR Enterococci were observed after the first prophylaxis. The detection of QS Enterobacteriaceae was recovered before the second and subsequent courses to a level of the initial composition (28/35 samples, 80.0% before the first course vs 23/33 samples, 69.7% before the second and subsequent courses, P=0.41). In contrast, the detection rate of QR CNS and Enterococci significantly increased at the second and subsequent courses, even before prophylaxis (8/35 samples, 22.9% before the first course vs 20/33 samples, 60.6% before the second and subsequent courses, P=0.003). The incomplete recovery of the initial bacterial composition was associated with a prophylactic interval of within 30 days. Of the patients receiving multiple prophylactic courses, six had QR Escherichia coli, including extended-spectrum β-lactamase (ESBL) producers, at the first course, and four (66.3%) of the six patients had persistent detection of QR E. coli at the second course. Conclusion In patients receiving multiple courses of prophylactic quinolone, along with a common chemotherapy schedule, newly emergent resistant bacteria could be frequently persistent in their fecal flora.
Collapse
Affiliation(s)
- Yong Chong
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences
| | - Shinji Shimoda
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences
| | - Noriko Miyake
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences
| | - Takatoshi Aoki
- Department of Blood and Marrow Transplantation, Hara-Sanshin Hospital, Fukuoka
| | - Yoshikiyo Ito
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu
| | - Tomohiko Kamimura
- Department of Blood and Marrow Transplantation, Hara-Sanshin Hospital, Fukuoka
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| |
Collapse
|
8
|
Modi D, Jang H, Kim S, Surapaneni M, Sankar K, Deol A, Ayash L, Bhutani D, Lum LG, Ratanatharathorn V, Manasa R, Mellert K, Chandrasekar P, Uberti JP. Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients. Support Care Cancer 2017; 25:2593-2601. [PMID: 28365897 DOI: 10.1007/s00520-017-3670-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/14/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years. METHODS We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100 days after transplant, frequency of ICU admissions, and incidence and type of bacteremia. RESULTS Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100 days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p = 0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p = 0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5-24) days] compared to patients with prophylaxis [79%; median 7 (range, 3-36) days, p = 0.04]. CONCLUSION Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.
Collapse
Affiliation(s)
- Dipenkumar Modi
- Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
| | - Hyejeong Jang
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA
| | - Malini Surapaneni
- Department of Internal Medicine, 3990 John R, 5904 5Hudson, Detroit, MI, 48201, USA
| | - Kamya Sankar
- Wayne State School of Medicine, 320 E Canfield Ave; Suite 315, Detroit, MI, 48201, USA
| | - Abhinav Deol
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA
| | - Lois Ayash
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA
| | - Divaya Bhutani
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA
| | - Lawrence G Lum
- Division of Hematology/Oncology, University of Virginia Cancer Center, West Complex, Rm 7191, 1300 Jefferson Park Avenue, Charlottesville, VA, USA
| | - Voravit Ratanatharathorn
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA
| | - Richard Manasa
- Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA
| | - Kendra Mellert
- Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA
| | | | - Joseph P Uberti
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA
| |
Collapse
|
9
|
Jang IY, Yoon DH, Kim S, Lee K, Kim KK, Lim YM, Min WK, Suh C. Advanced POEMS syndrome treated with high-dose melphalan followed by autologous blood stem cell transplantation: a single-center experience. Blood Res 2014; 49:42-8. [PMID: 24724066 PMCID: PMC3974956 DOI: 10.5045/br.2014.49.1.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/22/2014] [Accepted: 02/19/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND POEMS syndrome is a rare paraneoplastic syndrome associated with plasma cell dyscrasia. High-dose chemotherapy followed by autologous stem cell transplantation has shown encouraging efficacy in the treatment of patients with POEMS syndrome. However, there are minimal reports on clinical outcomes after autologous stem cell transplantation for patients with advanced disease and very poor performance status. METHODS We retrospectively evaluated 9 advanced POEMS syndrome patients, who had an Eastern Cooperative Oncology Group performance status score of 3 or 4, and were treated with high-dose melphalan therapy followed by autologous stem cell transplantation from 2004 to 2011. RESULTS Eight patients achieved initial hematologic response, 4 of whom had complete responses. At a median follow-up of 44 months (range, 8-94 months), 7 patients were alive, with 3-year overall survival rate of 77.8%. There were no hematologic relapses in the survivors. One patient died of disease progression; the other died of pneumonia despite a hematologic response 3 months after autologous stem cell transplantation. All survivors achieved improvement in general performance status and in clinical response. CONCLUSION High-dose melphalan followed by autologous stem cell transplantation can be considered a valid treatment option even for patients with advanced POEMS syndrome.
Collapse
Affiliation(s)
- Il-Young Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungmin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Clinical impact of fluoroquinolone-resistant Escherichia coli in the fecal flora of hematological patients with neutropenia and levofloxacin prophylaxis. PLoS One 2014; 9:e85210. [PMID: 24465506 PMCID: PMC3898953 DOI: 10.1371/journal.pone.0085210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is said to be effective on febrile netropenia (FN)-related infection and mortality; however, the emergence of antibiotic resistance has become a concern. Ciprofloxacin and levofloxacin prophylaxis are most commonly recommended. A significant increase in the rate of quinolone-resistant Escherichia coli in fecal flora has been reported following ciprofloxacin prophylaxis. The acquisition of quinolone-resistant E. coli after levofloxacin use has not been evaluated. METHODS We prospectively examined the incidence of quinolone-resistant E. coli isolates recovered from stool cultures before and after levofloxacin prophylaxis in patients with neutropenia from August 2011 to May 2013. Some patients received chemotherapy multiple times. RESULTS In this trial, 68 patients were registered. Levofloxacin-resistant E. coli isolates were detected from 11 and 13 of all patients before and after the prophylaxis, respectively. However, this was not statistically significant (P = 0.65). Multiple prophylaxis for sequential chemotherapy did not induce additional quinolone resistance among E. coli isolates. Interestingly, quinolone-resistant E. coli, most of which were extended-spectrum β-lactamase (ESBL) producers, were already detected in approximately 20% of all patients before the initiation of prophylaxis. FN-related bacteremia developed in 2 patients, accompanied by a good prognosis. CONCLUSIONS Levofloxacin prophylaxis for neutropenia did not result in a significant acquisition of quinolone-resistant E. coli. However, we detected previous colonization of quinolone-resistant E. coli before prophylaxis, which possibly reflects the spread of ESBL. The epidemic spread of resistant E. coli as a local factor may influence strategies toward the use of quinolone prophylaxis.
Collapse
|
11
|
Sato M, Nakasone H, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Kawamura K, Ashizawa M, Machishima T, Terasako K, Kimura SI, Kikuchi M, Tanihara A, Yamazaki R, Tanaka Y, Kanda J, Kako S, Nishida J, Kanda Y. Prediction of infectious events by the high-sensitivity C-reactive protein level before autologous hematopoietic cell transplantation for lymphoma and multiple myeloma. Transpl Infect Dis 2013; 15:E169-71. [PMID: 23782409 DOI: 10.1111/tid.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/04/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
|