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Ejaz A, Belgaumi AF, Alam SE, Ashraf MS, Raza MR. Effectiveness of levofloxacin in the induction of chemotherapy in high-risk acute lymphoblastic leukaemia in children in a developing country. Ecancermedicalscience 2023; 17:1606. [PMID: 37799940 PMCID: PMC10550328 DOI: 10.3332/ecancer.2023.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Indexed: 10/07/2023] Open
Abstract
Background Infections significantly predominate during induction chemotherapy for acute lymphoblastic leukaemia (ALL) in children. Antibacterial prophylaxis is one strategy that lowers the risk of these infections. This study evaluates the role of levofloxacin prophylaxis on the frequency of infections, febrile neutropenia (FN) and outcomes associated with it along with the development of drug-resistance. Subject and methods This was a single-centre cohort study in which the data were collected from electronic health records between two cohorts of high-risk ALL patients in the induction phase: the first one before the initiation of levofloxacin prophylaxis and the second was after the implementation of levofloxacin prophylaxis. The variables were compared between both the groups and odds ratios were calculated for clinical outcomes. Results Out of 227 patients, 115 were given levofloxacin prophylaxis and 112 were in the no prophylaxis group. Both cohorts were similar in demographic factors, treatment regimen and supportive care services. There was a significant difference in total in-patient admissions along with FN admissions (p = 0.026). Microbiologically documented infections and infection-related critical interventions were significantly higher in the no prophylaxis group (p < 0.05). Odds ratios with a 95% confidence interval were applied to both groups for clinical outcomes in patients with and without FN which also illustrated similar results. Overall mortality and drug resistance patterns were similar among both groups. Conclusion This study emphasised that levofloxacin is effective in reducing inpatient admissions with FN and its complications but did not affect the drug-resistance pattern. Long-term monitoring for antibiotic resistance is mandatory.
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Affiliation(s)
- Areeba Ejaz
- Indus Hospital and Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, Pakistan
| | | | - Syed Ejaz Alam
- Pakistan Medical and Research Council, PMRC Center for Hepatology and Gastroenterology, JPMC, Rafiqi H J Rd, Cantonment Karachi, 75510, Karachi City, Sindh, Pakistan
| | - Mohammad Shamvil Ashraf
- Indus Hospital and Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, Pakistan
| | - Mohammad Rafie Raza
- Indus Hospital and Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, Pakistan
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Alrawashdh N, McBride A, Oh M, Alkhatib N, Lee C, Martin J, MacDonald K, Abraham I. Meta-Analysis of Same-Day Pegfilgrastim Administration Stratified by Myelotoxic Febrile Neutropenia Risk and Tumor Type. J Adv Pract Oncol 2022; 13:796-811. [PMID: 36727017 PMCID: PMC9881740 DOI: 10.6004/jadpro.2022.13.8.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Pegfilgrastim is recommended to be administered at least 24 hours following the completion of chemotherapy, yet some clinicians use a same-day administration protocol. In this meta-analysis, we compared the incidence of chemotherapy-induced (febrile) neutropenia (CIN/FN) as well as CIN/FN-related chemotherapy disruptions in cancer patients provided with pegfilgrastim same-day vs. next-day. Methods Six databases were searched for comparative studies of same-day vs. next-day pegfilgrastim administration. Fixed or random-effects meta-analyses were conducted to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results Thirteen studies were included in this meta-analysis. The FN OR for same-day vs. next-day administration was 1.48 (95% CI = 1.06-2.08) across all cycles, attributable mainly to studies of high FN risk (OR = 2.46, 95% CI = 1.04-5.83) vs. intermediate FN risk regimens (OR = 1.41, 95% CI = 0.95-2.10), and breast cancer (OR = 3.15, 95% CI = 1.24-8.01) vs. non-Hodgkin lymphoma (NHL; OR = 1.48, 95% CI = 0.98-2.23) and gynecologic cancers (OR = 0.64, 95% CI = 0.11-3.85). Where available, ORs for first cycle of chemotherapy, grades 3 and/or 4 CIN, and chemotherapy dose delays or reductions were in line with these findings. Conclusion In this independent study, same-day pegfilgrastim administration may or may not increase the likelihood of FN, grades 3 and/or 4 CIN, and chemotherapy dose reductions or delays; and this may be a function of the myelotoxicity of the regimens (elevated in high-risk but not intermediate-risk regimens) and tumor type (elevated in breast but not in NHL or gynecologic cancers). With due caution, same-day pegfilgrastim administration may be safe and beneficial in intermediate-risk regimens and selected tumor types.
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Affiliation(s)
- Neda Alrawashdh
- From Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona,Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, Arizona
| | - Ali McBride
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona
| | - Mok Oh
- From Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona
| | - Nimer Alkhatib
- From Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona
| | - Christopher Lee
- Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Jennifer Martin
- Arizona Health Sciences Library, University of Arizona, Tucson, Arizona
| | | | - Ivo Abraham
- From Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona,Matrix45, Tucson, Arizona
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Mehta Y, Mishra KC, Paliwal Y, Rangappa P, Sinha S, Bhapkar S. Meeting the Unmet Need in the Management of MDR Gram-Positive Infections with Oral Bactericidal Agent Levonadifloxacin. Crit Care Res Pract 2022; 2022:2668199. [PMID: 36785544 DOI: 10.1155/2022/2668199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
Levonadifloxacin (intravenous) and its oral prodrug alalevonadifloxacin are broad-spectrum antibacterial agents developed for the treatment of difficult-to-treat infections caused by multidrug-resistant Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus, atypical bacteria, anaerobic bacteria, and biodefence pathogens as well as Gram-negative bacteria. Levonadifloxacin has a well-defined mechanism of action involving a strong affinity for DNA gyrase as well as topoisomerase IV. Alalevonadifloxacin with widely differing solubility and oral bioavailability has pharmacokinetic profile identical to levonadifloxacin. Unlike existing MRSA drugs such as vancomycin and linezolid, which cause unfavorable side effects like nephrotoxicity, bone-marrow toxicity, and muscle toxicity, levonadifloxacin/alalevonadifloxacin has demonstrated superior safety and tolerability features with no serious adverse events. Levonadifloxacin/alalevonadifloxacin could be a useful weapon in the battle against infections caused by resistant microorganisms and could be a preferred antibiotic of choice for empirical therapy in the future.
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Hapakova N, Chovanec M, Rejlekova K, Kalavska K, Obertova J, Palacka P, De Angelis V, Svetlovska D, Sycova‑Mila Z, Mardiak J, Mego M. Effects of primary granulocyte‑colony stimulating factor prophylaxis on the incidence of febrile neutropenia in patients with germ cell tumors. Oncol Lett 2022; 24:308. [PMID: 35949605 PMCID: PMC9353223 DOI: 10.3892/ol.2022.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Testicular germ cell tumors (GCTs) are the most common solid malignancy in males aged 15–35 years. Febrile neutropenia (FN) is a serious complication of chemotherapy that frequently occurs in patients with GCTs. The present retrospective study aimed to evaluate the effect of primary granulocyte-colony stimulating factor (G-CSF) prophylaxis on the incidence of FN in patients with GCTs. The present study included a review of the medical records of patients diagnosed with GCTs treated with first-line/adjuvant chemotherapy between January 2000 and December 2017 at the National Cancer Institute (Bratislava, Slovakia). In January 2006, a decision was made to administer G-CSF prophylaxis (filgrastim or pegfilgrastim) to patients after every cycle of chemotherapy. The present study included 385 patients, and out of these, 264 patients received primary G-CSF prophylaxis, while 121 patients did not. A total of 71 patients (18.4%) suffered from FN events. In the subgroup that did not receive primary prophylaxis, 42 patients exhibited FN, while only 29 patients with primary prophylaxis suffered from FN (34.7 vs. 11.0%; P=0.00000003). According to the subgroup analysis, FN incidence was decreased in all groups that received primary prophylaxis, except for patients with stage I GCT receiving adjuvant chemotherapy, without affecting overall survival. Primary G-CSF prophylaxis was associated with markedly reduced FN incidence in patients treated with first-line chemotherapy for metastatic disease. Therefore, the results of the present study suggested that primary G-CSF prophylaxis should be considered in patients with GCT receiving first-line chemotherapy.
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Affiliation(s)
- Nikola Hapakova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Michal Chovanec
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Katarina Rejlekova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Katarina Kalavska
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Jana Obertova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Patrik Palacka
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Valentina De Angelis
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Daniela Svetlovska
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Zuzana Sycova‑Mila
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Jozef Mardiak
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Michal Mego
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
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Eryilmaz-Eren E, Izci F, Ture Z, Sagiroglu P, Kaynar L, Ulu-Kilic A. Bacteremia in Hematopoietic Stem Cell Recipients Receiving Fluoroquinolone Prophylaxis: Incidence, Resistance, and Risk Factors. Infect Chemother 2022; 54:446-455. [PMID: 36047301 PMCID: PMC9533163 DOI: 10.3947/ic.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and Methods This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.
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Affiliation(s)
- Esma Eryilmaz-Eren
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kayseri City Education and Research Hospital, Kayseri, Türkiye
| | - Feyza Izci
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye
| | - Zeynep Ture
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye
| | - Pinar Sagiroglu
- Department of Medical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye
| | - Leylagul Kaynar
- Department of Hematology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye
| | - Aysegul Ulu-Kilic
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye
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Akhmedov M. Infectious complications in allogeneic hematopoietic cell transplant recipients: Review of transplant-related risk factors and current state of prophylaxis. Clin Transplant 2020; 35:e14172. [PMID: 33247497 DOI: 10.1111/ctr.14172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 01/23/2023]
Abstract
Allogeneic hematopoietic cell transplantation is a complex procedure that carries a significant risk of complications. Infections are among the most common of them. Several direct factors such as neutropenia, hypogammaglobulinemia, lymphopenia, mucosal barrier injury, and graft-versus-host disease have been shown to be associated with increased infectious risk post-transplant. Apart from direct factors, there are also indirect transplant-related factors that are the primary trigger to the formers' development. The most important of them are type of preparative regimen, graft source, donor type, graft-versus-host disease prophylaxis, and graft manipulation techniques. In this review, an attempt has been made to summarize the role of the transplant-related factors in the development of infectious complications and provide evidence underlying the current concept of infectious disease prophylaxis in patients after allogeneic hematopoietic cell transplantation.
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Affiliation(s)
- Mobil Akhmedov
- Department of Bone Marrow Transplantation, National Hematology Research Center, Moscow, Russian Federation
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7
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Anaya-Gonzalez C, Soldevila S, Garcia-Lainez G, Bosca F, Andreu I. Chemical tuning for potential antitumor fluoroquinolones. Free Radic Biol Med 2019; 141:150-158. [PMID: 31195085 DOI: 10.1016/j.freeradbiomed.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Phototoxic effects of 6,8 dihalogenated quinolones confers to this type of molecules a potential property as photochemotherapeutic agents. Two photodehalogenation processes seem to be involved in the remarkable photoinduced cellular damage. In this context, a new 6,8 dihalogenated quinolone 1 (1-methyl-6,8-difluoro-4-oxo-7-aminodimethyl-1,4-dihydroquinoline-3-carboxylic acid) was synthetized looking for improving the phototoxic properties of fluoroquinolones (FQ) and to determine the role of the photodegradation pathways in the FQ phototoxicity. With this purpose, fluorescence emissions, laser flash photolysis experiments and photodegradation studies were performed with compound 1 using 1-ethyl-6,8-difluoro-4-oxo-7-aminodimethyl-1,4-dihidroquinoline-3-carboxylic acid (2) and lomefloxacin (LFX) as reference compounds. The shortening of alkyl chain of the N(1) of the quinolone ring revealed a lifetime increase of the reactive aryl cation generated from photolysis of the three FQ and a significant reduction of the FQ photodegradation quantum yield. The fact that these differences were smaller when the same study was done using a hydrogen donor solvent (ethanol-aqueous buffer, 50/50 v/v) evidenced the highest ability of the reactive intermediate arising from 1 to produce intermolecular alkylations. These results were correlated with in vitro 3T3 NRU phototoxicity test. Thus, when Photo-Irritation-Factor (PIF) was determined for 1, 2 and LFX using cytotoxicity profiles of BALB/c 3T3 fibroblasts treated with each compound in the presence and absence of UVA light, a PIF more higher than 30 was obtained for 1 while the values for 2 and LFX were only higher than 8 and 10, respectively. Thereby, the present study illustrates an approach to modulate the photosensitizing properties of FQ with the purpose to improve the chemotherapeutic properties of antitumor quinolones. Moreover, the results obtained in this study also evidence that the key pathway responsible for the phototoxic properties associated with dihalogenated quinolones is the aryl cation generation.
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Affiliation(s)
- Cristina Anaya-Gonzalez
- Instituto Mixto de Tecnología Química. Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV) Avd. Los Naranjos s/n, 46022, Valencia, Spain
| | - Sonia Soldevila
- Instituto Mixto de Tecnología Química. Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV) Avd. Los Naranjos s/n, 46022, Valencia, Spain
| | - Guillermo Garcia-Lainez
- Instituto de Investigación Sanitaria (IIS) La Fe, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Francisco Bosca
- Instituto Mixto de Tecnología Química. Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV) Avd. Los Naranjos s/n, 46022, Valencia, Spain.
| | - Inmaculada Andreu
- Instituto de Investigación Sanitaria (IIS) La Fe, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain; Unidad Mixta de Investigación UPV-Instituto de Investigación Sanitaria (IIS) La Fe, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
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Misch EA, Andes DR. Bacterial Infections in the Stem Cell Transplant Recipient and Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:399-445. [DOI: 10.1016/j.idc.2019.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sulis ML, Blonquist TM, Stevenson KE, Hunt SK, Kay-Green S, Athale UH, Clavell LA, Cole PD, Kelly KM, Laverdiere C, Leclerc JM, Michon B, Schorin MA, Welch JG, Neuberg DS, Sallan SE, Silverman LB. Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2018; 65:e26952. [PMID: 29319209 DOI: 10.1002/pbc.26952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. METHODS Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. RESULTS Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different. CONCLUSION For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.
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Affiliation(s)
- M L Sulis
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital New York, New York
| | - T M Blonquist
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - K E Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - S K Hunt
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - S Kay-Green
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - U H Athale
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, ON, Canada
| | - L A Clavell
- Division of Pediatric Oncology, San Jorge Children's Hospital, San Juan, Puerto Rico
| | - P D Cole
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - K M Kelly
- Division of Pediatric Hematology/Oncology, Women and Children's Hospital of Buffalo, Roswell Park Cancer Institute, Buffalo, New York
| | - C Laverdiere
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - J M Leclerc
- Division of Hematology and Oncology, Hospital Sainte-Justine, University of Montreal, Montreal, Canada
| | - B Michon
- Division of Hematology-Oncology, Centre Hospitalier Universite' de Quebec, Quebec City, Canada
| | - M A Schorin
- Division of Pediatric Hematology-Oncology, Inova Children's Hospital, Falls Church, Virginia
| | - J G Welch
- Division of Pediatric Hematology-Oncology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - D S Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - S E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - L B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Cho SY, Lee HJ, Lee DG. Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea. Korean J Intern Med 2018; 33:256-276. [PMID: 29506345 PMCID: PMC5840605 DOI: 10.3904/kjim.2018.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/28/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a treatment for hematologic malignancies, immune deficiencies, or genetic diseases, ect. Recently, the number of HSCTs performed in Korea has increased and the outcomes have improved. However, infectious complications account for most of the morbidity and mortality after HSCT. Post-HSCT infectious complications are usually classified according to the time after HSCT: pre-engraftment, immediate post-engraftment, and late post-engraftment period. In addition, the types and risk factors of infectious complications differ according to the stem cell source, donor type, conditioning intensity, region, prophylaxis strategy, and comorbidities, such as graft-versushost disease and invasive fungal infection. In this review, we summarize infectious complications after HSCT, focusing on the Korean perspectives.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Jeong Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Dong-Gun Lee, M.D. Division of Infectious Diseases, Department of Internal Medicine, The Catholic Blood and Marrow Transplantation Centre, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6003 Fax: +82-2-535-2494 E-mail:
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11
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Fournier Q, Serra JC, Handel I, Lawrence J. Impact of Pretreatment Neutrophil Count on Chemotherapy Administration and Toxicity in Dogs with Lymphoma Treated with CHOP Chemotherapy. J Vet Intern Med 2017; 32:384-393. [PMID: 29205493 PMCID: PMC5787211 DOI: 10.1111/jvim.14895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
Background Prechemotherapy absolute neutrophil count (ANC) cutoffs are arbitrary and vary across institutions and clinicians. Similarly, subjective guidelines are utilized for the administration of prophylactic antibiotics in neutropenic dogs. Objectives To evaluate the impact of various ANC cutoffs on chemotherapy administration in dogs with lymphoma treated with CHOP chemotherapy and to determine whether an association between prechemotherapy ANC and subsequent toxicity exists. The secondary objective was to evaluate a currently used ANC cutoff to indicate prescription of prophylactic antibiotics. Animals Dogs diagnosed with lymphoma treated with CHOP chemotherapy (n = 64). Methods Six hundred and fifteen ANCs were stratified into 6 classes. The 3 ANC cutoffs 1.5 × 103/μL, 2.0 × 103/μL, and 2.5 × 103/μL were assessed. The presence of an association between prechemotherapy ANC class and toxicity was determined. Afebrile neutropenic dogs with ANC <1.5 × 103/μL but above the criteria for prophylactic antibiotics were evaluated. Results Chemotherapy was not administered in 7% of visits with an ANC cutoff of 1.5 × 103/μL; chemotherapy would not have been administered in 10% and 16% of visits with an ANC cutoff of 2.0 × 103/μL or 2.5 × 103/μL, respectively. There was no association among the 3 lower prechemotherapy ANC classes and toxicity. All dogs with ANC 0.75–1.5 × 103/μL recovered spontaneously without medical intervention. Conclusion and Clinical Importance The number of dose delays was minimized with a prechemotherapy ANC cutoff of 1.5 × 103/μL, and the prechemotherapy ANC class 1.5–1.99 × 103/μL was not associated with an increased toxicity. Further investigation of an ANC cutoff near 0.75 × 103/μL in which to prescribe prophylactic antibiotics is indicated.
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Affiliation(s)
- Q Fournier
- Royal (Dick) School of Veterinary Studies, Roslin Institute, The University of Edinburgh, Roslin, UK
| | - J-C Serra
- Royal (Dick) School of Veterinary Studies, Roslin Institute, The University of Edinburgh, Roslin, UK
| | - I Handel
- Royal (Dick) School of Veterinary Studies, Roslin Institute, The University of Edinburgh, Roslin, UK
| | - J Lawrence
- Royal (Dick) School of Veterinary Studies, Roslin Institute, The University of Edinburgh, Roslin, UK
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Osmani AH, Jabbar AA, Gangwani MK, Hassan B. Outcomes of High Risk Patients with Febrile Neutropenia at a Tertiary Care Center. Asian Pac J Cancer Prev 2017; 18:2741-2745. [PMID: 29072402 PMCID: PMC5747398 DOI: 10.22034/apjcp.2017.18.10.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Fever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality in cancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status, comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia (FN) are observed in those with documented infection. The objectives of the study were to present available tools for risk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes.
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Affiliation(s)
- Asif Husain Osmani
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
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Subburaj D, Uppuluri R, Jayaraman D, Vellaichamyswaminathan V, Kandath S, Raj R. Combating blood stream infections during induction chemotherapy in children with acute myeloid leukemia: Single center results in India. Pediatr Blood Cancer 2017; 64. [PMID: 28332765 DOI: 10.1002/pbc.26517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 01/31/2023]
Abstract
Optimal management of infectious complication is the biggest challenge in children receiving chemotherapy for acute myeloid leukemia (AML). We have analyzed the data of children undergoing AML induction chemotherapy at our center from 2002 to 2016 and found that Gram-negative infections are more predominant when compared to the published literature. There also has been a surge in multidrug-resistant (MDR) infections over the last 4 years, which has increased the need for supportive care and escalated the cost of care. We have introduced certain novel methods to combat MDR sepsis and decrease mortality rates.
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Affiliation(s)
- Divya Subburaj
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | - Dhaarani Jayaraman
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
| | | | - Sathishkumar Kandath
- Department of Pediatric Critical Care Group, Apollo Speciality Hospital, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Apollo Speciality Hospital, Chennai, India
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Abstract
PURPOSE OF REVIEW Improved management of infectious complications of acute myeloid leukemia (AML) has contributed substantially to the success of care over the past half century. An important approach to reducing infectious complications during the induction period of chemotherapy involves the use of prophylactic antibacterial, antiviral, and antifungal agents targeting likely pathogens. RECENT FINDINGS There is not a one-size-fits-all approach to prophylaxis; every patient undergoing induction therapy should be evaluated individually and within the context of local microbiologic epidemiology and host risk factors. Pharmacologic and non-pharmacologic interventions as well as novel diagnostic platforms can help mitigate the risk of life-threatening infection in patients with AML who undergo induction chemotherapy.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 331, New York, NY, 10065, USA.
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Medical Mycology Research Laboratory, Weill Cornell Medical Center, New York, NY, USA
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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16
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Nishikawa M, Miyake H, Fujisawa M. Identification of risk factors predicting febrile neutropenia in patients with metastatic germ cell tumors receiving cisplatin-based combination chemotherapy. Int J Urol 2017; 24:449-453. [PMID: 28421640 DOI: 10.1111/iju.13352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify clinical features and predictive factors of febrile neutropenia in Japanese patients with metastatic germ cell tumors undergoing cytotoxic chemotherapy. METHODS Between April 2007 and May 2016, 86 consecutive Japanese patients with metastatic germ cell tumors were treated with cisplatin-based combination chemotherapy, including bleomycin, etoposide and cisplatin, and paclitaxel, ifosfamide and cisplatin. A total of 378 chemotherapy cycles administered for these 86 patients were retrospectively analyzed. RESULTS During the 378 cycles, consisting of 212 for bleomycin, etoposide and cisplatin, and 166 for paclitaxel, ifosfamide and cisplatin, 81 episodes of febrile neutropenia (21.4%) developed in 34 patients (39.5%). Multivariate logistic regression analysis showed that low estimated glomerular filtration rate and albumin levels were independent risk factors for the development of febrile neutropenia. Furthermore, a significant difference in the incidence of febrile neutropenia was noted according to positive numbers of these two independent risk factors; that is, febrile neutropenia occurred in 13 of 171 courses in patients negative for any risk factors (7.6%), 44 of 155 courses in those positive for a single risk factor (28.4%) and 24 of 52 courses in those positive for two risk factors (46.2%). CONCLUSIONS The incidence of febrile neutropenia in Japanese metastatic germ cell tumor patients receiving cisplatin-based combination chemotherapy appears to be higher than reported previously by studies in Western countries. When carrying out cytotoxic chemotherapy, special attention should be paid to patients with low estimated glomerular filtration rate and/or albumin levels considering the high probability of febrile neutropenia.
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Affiliation(s)
- Masatomo Nishikawa
- Department of Urology, Seirei Mikatabara Hospital, Hamamatsu, Japan.,Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Al Omar S, Anabtawi N, Al Qasem W, Rihani R. Bacterial Infections in Children With Acute Myeloid Leukemia Receiving Ciprofloxacin Prophylaxis. J Pediatr Hematol Oncol 2017; 39:e131-5. [PMID: 28234737 DOI: 10.1097/MPH.0000000000000792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of the study was to describe the incidence and type of bacterial infections associated with the use of ciprofloxacin prophylaxis as single agent in pediatric patients with acute myeloid leukemia (AML). PROCEDURE This was a retrospective review of all patients with AML, who were treated according to the AML02 protocol between 2011 and 2015. The medical records were reviewed for any positive cultures from the initiation of the protocol until death or protocol discontinuation. Patient demographics, type of infections, type of isolated bacteria, and intensive care unit admissions were recorded. RESULTS A total of 50 patients were evaluated, who were of a mean age of 8 years±5.1 (SD). We identified 77 episodes of bacterial infections in 42 (84%) patients. Among those bacterial infections, 73 episodes were with bacteremia and included 45 (62%) gram-positive bacterial infections, 24 (33%) gram-negative bacterial infections, and 4 (6%) mixed gram-negative and gram-positive bacterial infections. Coagulase-negative Staphylococcus and Viridans streptococci were the most commonly isolated bacteria in 33% and 30% of the episodes, respectively. Seventeen (45%) patients with bacteremia required intensive care unit admission. CONCLUSIONS A high rate of bacterial infection was detected in patients who received the AML02 protocol, mainly gram-positive bacterial infections. The prophylactic regimen should be reconsidered for its efficacy, and other antibacterial prophylaxis may be used.
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Fu JB, Lee J, Shin BC, Silver JK, Smith DW, Shah JJ, Bruera E. Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit. PM R 2017; 9:571-8. [DOI: 10.1016/j.pmrj.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022]
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19
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Fukae M, Shiraishi Y, Hirota T, Sasaki Y, Yamahashi M, Takayama K, Nakanishi Y, Ieiri I. Population pharmacokinetic–pharmacodynamic modeling and model-based prediction of docetaxel-induced neutropenia in Japanese patients with non-small cell lung cancer. Cancer Chemother Pharmacol 2016; 78:1013-1023. [DOI: 10.1007/s00280-016-3157-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
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20
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Sahin U, Toprak SK, Atilla PA, Atilla E, Demirer T. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation. J Infect Chemother 2016; 22:505-14. [PMID: 27344206 DOI: 10.1016/j.jiac.2016.05.006] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/05/2016] [Accepted: 05/20/2016] [Indexed: 12/31/2022]
Abstract
Infections are the most common and significant cause of mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The presence of neutropenia and mucosal damage are the leading risk factors in the early pre-engraftment phase. In the early post-engraftment phase, graft versus host disease (GvHD) induced infection risk is increased in addition to catheter related infections. In the late phase, in which reconstitution of cellular and humoral immunity continues, as well as the pathogens seen during the early post-engraftment phase, varicella-zoster virus and encapsulated bacterial infections due to impaired opsonization are observed. An appropriate vaccination schedule following the cessation of immunosuppressive treatment after transplantation, intravenous immunoglobulin administration, and antimicrobial prophylaxis with penicillin or macrolide antibiotics during immunosuppressive treatment for GvHD might decrease the risk of bacterial infections. Older age, severe mucositis due to toxicity of chemotherapy, gastrointestinal tract colonization, prolonged neutropenia, unrelated donor and cord blood originated transplantations, acute and chronic GvHD are among the most indicative clinical risk factors for invasive fungal infections. Mold-active anti-fungal prophylaxis is suggested regardless of the period of transplantation among high risk patients. The novel serological methods, including Aspergillus galactomannan antigen and beta-D-glucan detection and computed tomography are useful in surveillance. Infections due to adenovirus, influenza and respiratory syncytial virus are encountered in all phases after allo-HSCT, including pre-engraftment, early post-engraftment and late phases. Infections due to herpes simplex virus-1 and -2 are mostly seen during the pre-engraftment phase, whereas, infections due to cytomegalovirus and human herpes virus-6 are seen in the early post-engraftment phase and Epstein-Barr virus and varicella-zoster virus infections often after +100th day. In order to prevent mortality and morbidity of infections after allo-HSCT, the recipients should be carefully followed-up with appropriate prophylactic measures in the post-transplant period.
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Affiliation(s)
- Ugur Sahin
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | | | - Pinar Ataca Atilla
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | - Erden Atilla
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | - Taner Demirer
- Ankara University Medical School, Department of Hematology, Ankara, Turkey.
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21
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Motoori M, Yano M, Miyata H, Sugimura K, Saito T, Omori T, Fujiwara Y, Miyoshi N, Akita H, Gotoh K, Takahashi H, Kobayashi S, Noura S, Ohue M, Asahara T, Nomoto K, Ishikawa O, Sakon M. Randomized study of the effect of synbiotics during neoadjuvant chemotherapy on adverse events in esophageal cancer patients. Clin Nutr 2017; 36:93-9. [PMID: 26644166 DOI: 10.1016/j.clnu.2015.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/18/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS The clinical value of synbiotics in patients receiving neoadjuvant chemotherapy currently remains unclear. The aim of this study was to investigate the effects of synbiotics in esophageal cancer patients receiving neoadjuvant chemotherapy on the intestinal microbiota and the adverse events of chemotherapy. METHODS Sixty-one patients with advanced esophageal cancer who were scheduled to receive neoadjuvant chemotherapy were randomly allocated to 2 groups. One group received synbiotics during chemotherapy (n = 30), while the other group did not (n = 31). The fecal microbiota and organic acid concentrations were analyzed. The primary endpoint was the incidence of chemotherapy-related adverse events. RESULTS The numbers of beneficial and harmful bacteria were significantly larger and smaller, respectively, in the synbiotics group than in the control group on day 10 of chemotherapy. The concentrations of acetic acid and propionic acid were significantly higher in the synbiotics group on day 10 of chemotherapy. The frequencies of severe lymphopenia and diarrhea were significantly less in the synbiotics group than in the control group (P = 0.033, 0.035, respectively). Furthermore, febrile neutropenia occurred less in the synbiotics group (10/30 in the synbiotics group vs 19/31 in the control group, P = 0.029). CONCLUSIONS Synbiotics during neoadjuvant chemotherapy in esophageal cancer patients reduced the occurrence of adverse events of chemotherapy through adjustments to the intestinal microbiota. (University Hospital Medical Information Network (http://www.umin.ac.jp), registration number UMIN000006875).
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Virizuela JA, Carratalà J, Aguado JM, Vicente D, Salavert M, Ruiz M, Ruiz I, Marco F, Lizasoain M, Jiménez-Fonseca P, Gudiol C, Cassinello J, Carmona-Bayonas A, Aguilar M, Cruz JJ. Management of infection and febrile neutropenia in patients with solid cancer. Clin Transl Oncol 2016; 18:557-70. [PMID: 26577106 DOI: 10.1007/s12094-015-1442-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/26/2015] [Indexed: 12/29/2022]
Abstract
An expert group from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, for its acronym in Spanish) and the Spanish Society of Medical Oncology (SEOM, for its acronym in Spanish) have reviewed the main aspects to be considered when evaluating patients with solid cancer and infectious complications contained in this article. Recommendations have, therefore, been put forth regarding the prophylaxis of the most prevalent infections in these patients, the use of vaccines, measures to control infection through vascular catheters, and preventing infection in light of certain surgical maneuvers. The following is a revision of the criteria for febrile neutropenia management and the use of colony-stimulating factors and closes with several guidelines for treating the cancer patient with serious infection. The document concludes with a series of measures to control hospital infection.
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Aguado JM, Cruz JJ, Virizuela JA, Aguilar M, Carmona A, Cassinello J, Gudiol C, Jiménez Fonseca P, Lizasoain M, Marco F, Ruiz I, Ruiz M, Salavert M, Vicente D, Carratalà J. Management of Infection and Febrile Neutropenia in Patients with Solid Cancer. Enferm Infecc Microbiol Clin 2015; 35:451-460. [PMID: 26279208 DOI: 10.1016/j.eimc.2015.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/24/2015] [Accepted: 06/15/2015] [Indexed: 12/22/2022]
Abstract
A group of experts from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Medical Oncology (SEOM) have reviewed in this paper the main aspects to be considered in the evaluation of patients with solid cancer and infectious diseases. They have established a series of recommendations on the prevention of the most prevalent infections in these patients, the use of vaccines, the control measures of vascular catheter infection and prevention of infections before certain surgical procedures. Also the criteria for management of febrile neutropenia and the use of colony-stimulating factors were revised. Finally they provide a series of recommendations for the treatment of cancer patients with severe infection. The document is completed with a series of measures for the control of hospital infection.
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Affiliation(s)
- José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Juan Jesús Cruz
- Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Juan Antonio Virizuela
- Servicio de Oncología Médica, Hospital Universitario Virgen de Macarena, Sevilla, España
| | - Manuela Aguilar
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Alberto Carmona
- Servicio de Oncología Médica, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Javier Cassinello
- Servicio de Oncología Médica, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Carlota Gudiol
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, Barcelona, España
| | - Paula Jiménez Fonseca
- Servicio de Oncología Médica, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Manuel Lizasoain
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España
| | - Francesc Marco
- Laboratori de Microbiologia, Centre de Diagnòstic Biomèdic (CDB), ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, España
| | - Isabel Ruiz
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Maribel Ruiz
- Servicio de Oncología Médica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Miguel Salavert
- Servicio de Enfermedades Infecciosas, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - David Vicente
- Servicio de Oncología Médica, Hospital Universitario Virgen de Macarena, Sevilla, España
| | - Jordi Carratalà
- Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, Barcelona, España
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Abstract
Patients with acute leukemia (AL) are at high risk for developing bacterial, viral and fungal infections during chemotherapy. Because these infections cause considerable morbidity and mortality, prevention is attractive. In recent decades, several trials have established the benefit of prophylactic antimicrobials in patients with AL. Administration of prophylactic fluoroquinolone, acyclovir and triazole is recommended in neutropenic patients with AL by both the USA and European national guidelines. The potential for antimicrobial resistance as a long-term consequence of prophylaxis, however, is a concern. The recent development of nonculture-based diagnostic tests for invasive fungal infections has made early diagnosis and targeted treatment a promising future strategy as an alternative to mold-active prophylaxis.
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Affiliation(s)
- Nina Cohen
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Ruhnke M, Arnold R, Gastmeier P. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. Lancet Oncol 2014; 15:e606-e619. [PMID: 25456379 DOI: 10.1016/s1470-2045(14)70344-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Drug-resistant Gram-negative and Gram-positive bacteria are now increasingly identified as a cause of infections in immunocompromised hosts. Bacteria identified include the multidrug-resistant (MDR) and even pandrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, as well as carbapenem-resistant Enterobacteriaceae spp. The threat from MDR pathogens has been well-documented in the past decade with warnings about the consequences of inappropriate use of antimicrobial drugs. Resistant bacteria can substantially complicate the treatment of infections in critically ill patients and can have a substantial effect on mortality. Inappropriate antimicrobial treatment can affect morbidity, mortality, and overall health-care costs. Evidence-based data for prevention and control of MDR pathogen infections in haematology are scarce. Although not yet established a bundle of infection control and prevention measures with an anti-infective stewardship programme is an important strategy in infection control, diagnosis, and antibiotic selection with optimum regimens to ensure a successful outcome for patients.
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Affiliation(s)
- Markus Ruhnke
- Department of Hematology and Oncology, Paracelsus-Hospital Osnabrück, Germany.
| | - Renate Arnold
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Virchow Klinikum, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
| | - Petra Gastmeier
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
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Abstract
Chemotherapy is frequently associated with hematologic toxicity. Neutropenia with or without fever is a relevant cause of morbidity, mortality and costs, compromising treatment administration and clinical outcomes. The development of granulocyte colony-stimulating factors has had a positive impact on the clinician's approach to neutropenia. Such agents, currently used for primary and secondary prophylaxis of chemotherapy-induced neutropenia and febrile neutropenia (FN), are effective in limiting hematologic toxicities and consequently allow the administration of intensive dose-dense regimens. Several biosimilar products of filgrastim have been developed over the years, showing effects similar to the originator drug. Until now, pegfilgrastim has been the only available long-acting factor, requiring just a single administration per chemotherapy cycle. The recent approval of the novel granulocyte colony-stimulating factors, lipegfilgrastim, offers interesting therapeutic alternatives. In fact, similar to pegfilgrastim, it has been demonstrated to reduce the duration of neutropenia and the occurrence of FN during chemotherapy safely.
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Affiliation(s)
- Margherita Ratti
- Oncology Division, Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
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Mealey KL, Dassanayake S, Burke NS. Tyrosine kinase inhibitors enhance ciprofloxacin-induced phototoxicity by inhibiting ABCG2. Oncology 2014; 87:364-70. [PMID: 25227759 DOI: 10.1159/000366132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/24/2014] [Indexed: 11/19/2022]
Abstract
The tyrosine kinase inhibitor (TKI) class of anticancer agents inhibits ABCG2-mediated drug efflux. ABCG2 is an important component of the blood-retinal barrier, where it limits retinal exposure to phototoxic compounds such as fluoroquinolone antibiotics. Patients treated with TKIs would be expected to be at greater risk for retinal phototoxicity. Using an in vitro system, our results indicate that the TKIs gefitinib and imatinib abrogate the ability of ABCG2 to protect cells against ciprofloxacin-induced phototoxicity. We conclude that the concurrent administration of ABCG2 inhibitors with photoreactive fluoroquinolone antibiotics may result in retinal damage.
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Affiliation(s)
- Katrina L Mealey
- Individualized Medicine Program, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Wash., USA
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Gilbar P, McPherson I, Sorour N, Sanmugarajah J. High incidence of febrile neutropenia following adjuvant breast chemotherapy with docetaxel, carboplatin and trastuzumab. Breast Cancer Management 2014. [DOI: 10.2217/bmt.14.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
SUMMARY Aim: To determine the incidence of febrile neutropenia (FN) following adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH) for early-stage breast cancer and the grade of neutropenia after cycle one. Methods: A retrospective multicenter audit of patients with early-stage breast cancer treated with TCH, was conducted at four Australian hospitals between October 2009 and September 2013. Results: Of 79 patients analyzed, data from 78 women were evaluated for FN incidence and data from 64 women were evaluated for grade of neutropenia. After cycle one of TCH, 26 patients developed FN (33.3%). Following all cycles, 32 patients developed FN (41.0%). There was no statistical difference in the incidence of FN between hospitals or between age groups (above or below 65 years). After cycle one, ten patients developed grade 3 neutropenia (15.6%) and 37 patients developed grade 4 neutropenia (57.8%). Conclusion: This study demonstrates a high incidence of FN post-TCH chemotherapy thus supporting the use of granulocyte colony-stimulating factor as primary prophylaxis.
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Affiliation(s)
- Peter Gilbar
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
- School of Medicine, University of Queensland (Rural Clinical Division), Toowoomba, QLD 4350, Australia
| | - Ian McPherson
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
| | - Natacha Sorour
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, QLD 4350, Australia
| | - Jasotha Sanmugarajah
- Department of Medical Oncology & School of Medicine, Griffith University, Gold Coast University Hospital, Southport, QLD 4215, Australia
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Soldevila S, Cuquerella MC, Bosca F. Understanding of the Photoallergic Properties of Fluoroquinolones: Photoreactivity of Lomefloxacin with Amino Acids and Albumin. Chem Res Toxicol 2014; 27:514-23. [DOI: 10.1021/tx400377s] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sonia Soldevila
- Instituto
Universitario Mixto
de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, Avenida de los Naranjos s/n, 46022 Valencia, Spain
| | - M. Consuelo Cuquerella
- Instituto
Universitario Mixto
de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, Avenida de los Naranjos s/n, 46022 Valencia, Spain
| | - Francisco Bosca
- Instituto
Universitario Mixto
de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, Avenida de los Naranjos s/n, 46022 Valencia, Spain
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Soldevila S, Consuelo Cuquerella M, Lhiaubet-Vallet V, Edge R, Bosca F. Seeking the mechanism responsible for fluoroquinolone photomutagenicity: a pulse radiolysis, steady-state, and laser flash photolysis study. Free Radic Biol Med 2014; 67:417-25. [PMID: 24316197 DOI: 10.1016/j.freeradbiomed.2013.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Abstract
The mechanism responsible for the remarkable photomutagenicity of fluoroquinolone (FQ) antibiotics remains unknown. For this reason, it was considered worthwhile to study in detail the interactions between DNA and a dihalogenated FQ such as lomefloxacin (LFX; one of the most photomutagenic FQs) and its N-acetyl derivative ALFX. Studies of photosensitized DNA damage by (A)LFX, such as formation of DNA single-strand breaks (SSBs), together with pulse radiolysis, laser flash photolysis, and absorption and fluorescence measurements, have shown the important effects of the cationic character of the piperazinyl ring on the affinity of this type of drug for DNA. Hence, the formation of SSBs was detected for LFX, whereas ALFX and ciprofloxacin (a monofluorated FQ) needed a considerably larger dose of light to produce some damage. In this context, it was determined that the association constant (Ka) for the binding of LFX to DNA is ca. 2×10(3)M(-1), whereas in the case of ALFX it is only ca. 0.5×10(3)M(-1). This important difference is attributed to an association between the cationic peripheral ring of LFX and the phosphate moieties of DNA and justifies the DNA SSB results. The analysis of the transient species detected and the photomixtures has allowed us to establish the intermolecular processes involved in the photolysis of FQ in the presence of DNA and 2'-deoxyguanosine (dGuo). Interestingly, although a covalent binding of the dihalogenated FQ to dGuo occurs, the photodegradation of FQ…DNA complexes did not reveal any significant covalent attachment. Another remarkable outcome of this study was that (A)LFX radical anions, intermediates required for the onset of DNA damage, were detected by pulse radiolysis but not by laser flash photolysis.
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Affiliation(s)
- Sonia Soldevila
- Instituto Universitario Mixto de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, 46022 Valencia, Spain
| | - M Consuelo Cuquerella
- Instituto Universitario Mixto de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, 46022 Valencia, Spain
| | - Virginie Lhiaubet-Vallet
- Instituto Universitario Mixto de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, 46022 Valencia, Spain
| | - Ruth Edge
- Dalton Cumbrian Facility, The University of Manchester, Cumbria CA24 3HA, UK
| | - Francisco Bosca
- Instituto Universitario Mixto de Tecnologia Quimica (UPV-CSIC), Universitat Politecnica de Valencia, 46022 Valencia, Spain.
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Chong Y, Shimoda S, Yakushiji H, Ito Y, Aoki T, Miyamoto T, Kamimura T, Shimono N, Akashi K. 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 DOI: 10.1371/journal.pone.0085210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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Campos CP. Prophylaxis with levofloxacin: bacterial infections and antimicrobial resistance in hematological malignancies✰✰See paper by Lopes LA et al. on pages 35–42. Rev Bras Hematol Hemoter 2014; 36:7-8. [PMID: 24624027 PMCID: PMC3948657 DOI: 10.5581/1516-8484.20140004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Bacterial and fungal infections continue to be a major cause of morbidity and mortality in severely neutropenic patients undergoing aggressive chemotherapy regimens or hematopoietic stem cell transplantation. Traditional granulocyte transfusion therapy, a logical approach in treating these infections, has been available for many years, and several controlled studies have shown this therapy to be useful. However, granulocyte transfusion therapy fell out of favor because the results were not clinically impressive, and adverse results were reported. These disappointing results were felt to be, in part, because of the low doses of granulocytes provided. More recent studies have attempted to increase the numbers of transfused cells by stimulating normal granulocyte donors with G-CSF (+/-corticosteroids). With these techniques, the number of granulocytes transfused can be increased 3-4 fold. The cells have been shown to circulate in recipients, and daily transfusions are capable of maintaining normal or near-normal blood neutrophil counts in previously severely neutropenic patients. The cells appear to function normally by a variety of in vitro and in vivo tests. Clinical benefit, as defined by survival or clearance of infection, has not been definitively determined. Results of an ongoing randomized controlled clinical trial should be available in the near future.
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Affiliation(s)
- Anthony A. Marfin
- Puget Sound Blood Center, Seattle, WA, USA
- Current Address: HIV Prevention Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas H. Price
- Puget Sound Blood Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
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Aarts MJ, Peters FP, Mandigers CM, Dercksen MW, Stouthard JM, Nortier HJ, van Laarhoven HW, van Warmerdam LJ, van de Wouw AJ, Jacobs EM, Mattijssen V, van der Rijt CC, Smilde TJ, van der Velden AW, Temizkan M, Batman E, Muller EW, van Gastel SM, Borm GF, Tjan-Heijnen VCG. Primary granulocyte colony-stimulating factor prophylaxis during the first two cycles only or throughout all chemotherapy cycles in patients with breast cancer at risk for febrile neutropenia. J Clin Oncol 2013; 31:4290-6. [PMID: 23630211 DOI: 10.1200/jco.2012.44.6229] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Early breast cancer is commonly treated with anthracyclines and taxanes. However, combining these drugs increases the risk of myelotoxicity and may require granulocyte colony-stimulating factor (G-CSF) support. The highest incidence of febrile neutropenia (FN) and largest benefit of G-CSF during the first cycles of chemotherapy lead to questions about the effectiveness of continued use of G-CSF throughout later cycles of chemotherapy. PATIENTS AND METHODS In a multicenter study, patients with breast cancer who were considered fit enough to receive 3-weekly polychemotherapy, but also had > 20% risk for FN, were randomly assigned to primary G-CSF prophylaxis during the first two chemotherapy cycles only (experimental arm) or to primary G-CSF prophylaxis throughout all chemotherapy cycles (standard arm). The noninferiority hypothesis was that the incidence of FN would be maximally 7.5% higher in the experimental compared with the standard arm. RESULTS After inclusion of 167 eligible patients, the independent data monitoring committee advised premature study closure. Of 84 patients randomly assigned to G-CSF throughout all chemotherapy cycles, eight (10%) experienced an episode of FN. In contrast, of 83 patients randomly assigned to G-CSF during the first two cycles only, 30 (36%) had an FN episode (95% CI, 0.13 to 0.54), with a peak incidence of 24% in the third cycle (ie, first cycle without G-CSF prophylaxis). CONCLUSION In patients with early breast cancer at high risk for FN, continued use of primary G-CSF prophylaxis during all chemotherapy cycles is of clinical relevance and thus cannot be abandoned.
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Affiliation(s)
- Maureen J Aarts
- Maureen J. Aarts and Vivianne C.G. Tjan-Heijnen, Maastricht University Medical Center, Maastricht; Frank P. Peters, Orbis Medical Center, Sittard-Geleen; Caroline M. Mandigers, Canisius Wilhelmina Hospital; Hanneke W. van Laarhoven and George F. Borm, Radboud University Nijmegen Medical Center; Saskia M. van Gastel; Comprehensive Cancer Centre East; George F. Borm, Nijmegen I, Nijmegen; M. Wouter Dercksen, Maxima Medical Center, Veldhoven; Laurence J. van Warmerdam, Catharina Hospital, Eindhoven; Jacqueline M. Stouthard, Maasstad Medical Center; Carin C. van der Rijt, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam; Hans J. Nortier, Leiden University Medical Center; Erdogan Batman, Diaconessenhuis Leiden, Leiden; Agnes J. van de Wouw, VieCuri Medical Center, Venlo; Esther M. Jacobs, Elkerliek Hospital, Helmond; Vera Mattijssen, Rijnstate Hospital, Arnhem; Tineke J. Smilde, Jeroen Bosch Hospital, 's-Hertogenbosch; Annette W. van der Velden, Martini Hospital, Groningen; Mehmet Temizkan, Hospital St Jansdal, Harderwijk; and Erik W. Muller, Slingeland Hospital, Doetinchem, the Netherlands
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Huoi C, Vanhems P, Nicolle MC, Michallet M, Bénet T. Incidence of hospital-acquired pneumonia, bacteraemia and urinary tract infections in patients with haematological malignancies, 2004-2010: a surveillance-based study. PLoS One 2013; 8:e58121. [PMID: 23472145 PMCID: PMC3589363 DOI: 10.1371/journal.pone.0058121] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 01/30/2013] [Indexed: 01/24/2023] Open
Abstract
Objective This study charted incidence trends of hospital-acquired (HA) pneumonia, bacteraemia and urinary tract infections (UTI) in a haematology department. Methods Prospective surveillance of hospital-acquired infections (HAI) was undertaken in a 42-bed haematology department of a university hospital. All patients hospitalized ≥48 hours between 1st January 2004 and 31st December 2010 were included. Definitions of HAI were based on a standardized protocol. The incidence was the number of events per 1000 patient-days at risk; only the first HAI was counted. Multivariate Poisson regression was fitted to assess temporal trends. Results Among 3 355 patients (58 063 patient-days at risk) included, 1 055 (31%) had HAI. The incidence of HA pneumonia, HA bacteraemia and HA UTI was respectively 3.3, 12.0 and 2.9 per 1000 patient-days at risk. HA bacteraemia incidence increased by 11% (95% confidence interval: +6%, +15%, P<0.001) per year, independently of neutropenia, central venous catheterization (CVC) and haematological disease. The incidences of HA pneumonia and HA UTI were stable. The most frequently isolated pathogens were Aspergillus spp. (59.2%) for pneumonia, coagulase-negative Staphylococcus (44.2%) for bacteraemia and enterobacteria (60%) for UTI. Conclusion The incidence of bacteraemia increased, indicating that factors other than CVC exposure, including chemotherapy with its impact on the immune system, could explain this trend. Further analytic studies are needed to explore the factors that could explain this trend.
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Affiliation(s)
- Catherine Huoi
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Epidemiology and Public Health Group, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, University of Lyon 1, Lyon, France
| | - Marie-Christine Nicolle
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mauricette Michallet
- Haematology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Epidemiology and Public Health Group, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, University of Lyon 1, Lyon, France
- * E-mail:
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Affiliation(s)
- Sonia Soldevila
- Instituto de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los Naranjos s/n, 46022-Valencia, Spain
| | - Francisco Bosca
- Instituto de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los Naranjos s/n, 46022-Valencia, Spain
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Affiliation(s)
- M. Consuelo Cuquerella
- Instituto
de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los
Naranjos s/n, 46022 Valencia, Spain
| | - Inmaculada Andreu
- Instituto
de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los
Naranjos s/n, 46022 Valencia, Spain
| | - Sonia Soldevila
- Instituto
de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los
Naranjos s/n, 46022 Valencia, Spain
| | - Francisco Bosca
- Instituto
de Tecnología Química, Consejo Superior de Investigaciones Científicas/Universidad Politécnica de Valencia (CSIC/UPV), Avd. Los
Naranjos s/n, 46022 Valencia, Spain
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Palumbo A, Bladé J, Boccadoro M, Palladino C, Davies F, Dimopoulos M, Dmoszynska A, Einsele H, Moreau P, Sezer O, Spencer A, Sonneveld P, San Miguel J. How to Manage Neutropenia in Multiple Myeloma. Clinical Lymphoma Myeloma and Leukemia 2012; 12:5-11. [DOI: 10.1016/j.clml.2011.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/14/2011] [Accepted: 11/09/2011] [Indexed: 11/20/2022]
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Juutilainen A, Hämäläinen S, Pulkki K, Kuittinen T, Nousiainen T, Jantunen E, Koivula I. Biomarkers for bacteremia and severe sepsis in hematological patients with neutropenic fever: multivariate logistic regression analysis and factor analysis. Leuk Lymphoma 2011; 52:2349-55. [PMID: 21756036 DOI: 10.3109/10428194.2011.597904] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We compared biomarkers and their changes as predictors for bacteremia and severe sepsis during neutropenic fever after intensive chemotherapy in hematological patients. Serum C-reactive protein (CRP), semi-quantative procalcitonin, aminoterminal pro-brain natriuretic peptide (NT-proBNP), cortisol, lactate, plasma antithrombin and fibrinogen were measured daily from day 0 to day 3/day 4 in 89 neutropenic fever episodes of 65 hematological patients. The best predictors for bacteremia and gram-negative bacteremia were procalcitonin and its change, with odds ratios (ORs) and 95% confidence intervals of 2.63 (1.56-4.44) and 3.20 (1.77-5.80) for bacteremia and 4.14 (2.00-8.58) and 5.04 (2.18-11.63) for gram-negative bacteremia, respectively. For severe sepsis, the best predictors were CRP and fibrinogen, with ORs of 1.94 (1.07-3.52) and 1.92 (1.05-3.54). Factor analysis provided two predictive factors: procalcitonin-NT-proBNP-antithrombin factor predicted gram-negative bacteremia and CRP-fibrinogen predicted severe sepsis. Applying a combination of markers reflecting different aspects of infection might improve the recognition of risk for complications in patients with neutropenic fever.
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Affiliation(s)
- Auni Juutilainen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland.
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Abstract
During the period of neutropenia induced by chemotherapy, patients have a high risk of infection. The use of antibiotic prophylaxis to reduce neutropenia-related complications in patients with cancer is still disputed. Recent meta-analysis and clinical trials demonstrated that antibiotic prophylaxis with quinolones reduces febrile episodes, bacterial infections and mortality in adult oncological patients with neutropenia induced by chemotherapy in acute leukaemia. In paediatric patients, the only randomized, double-blind, prospective study until now suggests that amoxicillin/clavulanate may represent an effective prophylactic treatment in reducing fever and infections in oncological children with neutropenia, with an efficacy that is statistically demonstrated only in patients with acute leukaemia. Considering the risk of resistances, antibiotic-prophylaxis should be used only in selected patients.
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Affiliation(s)
- Angelica Barone
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria di Parma, Italy
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Chong Y, Yakushiji H, Ito Y, Kamimura T. Clinical impact of fluoroquinolone prophylaxis in neutropenic patients with hematological malignancies. Int J Infect Dis 2011; 15:e277-81. [PMID: 21324723 DOI: 10.1016/j.ijid.2010.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/28/2010] [Accepted: 12/19/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The routine use of fluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is controversial. This prophylaxis has been reported to have a positive impact in reducing infection-related mortality, but the consequent development of antibiotic resistance has become a concern. This study assessed the effect of discontinuing quinolone prophylaxis on the etiology and the resistance pattern of blood culture isolates and on the prognosis among febrile neutropenic patients receiving chemotherapy. METHODS The results of blood cultures obtained from febrile neutropenic patients between January 2003 and June 2009 were analyzed; these results were available through a computer database set up in 2003. RESULTS Patients receiving quinolone prophylaxis between 2003 and 2005 showed a lower incidence of Gram-negative bacteria than patients not receiving prophylaxis between 2006 and 2009 (13.5%, n=9 vs. 48.1%, n=75). Interestingly, after discontinuing prophylaxis, approximately 70% of the Gram-negative bacteria isolated were quinolone-resistant, and some were extended-spectrum β-lactamase (ESBL) producers. The frequencies of quinolone-resistant Gram-positive bacteria isolated were similar between the period of quinolone prophylaxis and the period with no prophylaxis (61.1% vs. 64.3%). In both periods, all Gram-positive isolates were sensitive to vancomycin. The infection-related mortality was comparable between patients receiving prophylaxis and those not receiving prophylaxis (1.5%, n=1 vs. 1.3%, n=2). CONCLUSIONS These findings suggest that quinolone prophylaxis for neutropenia does not induce a significant increase in the growth of quinolone- and multidrug-resistant bacteria. Rather, discontinuing quinolone prophylaxis may induce a dramatic increase in the growth of Gram-negative bacteria, including ESBL producers. Our results suggest that the necessity for quinolone prophylaxis in neutropenic patients should be determined based on local antibiotic resistance patterns.
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Affiliation(s)
- Yong Chong
- Department of Blood and Marrow Transplantation, Hara-Sanshin Hospital, 1-8, Taihaku-cho Hakata-ku, Fukuoka, 812-0033, Japan.
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Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2010; 47:8-32. [PMID: 21095116 DOI: 10.1016/j.ejca.2010.10.013] [Citation(s) in RCA: 735] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.
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Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland.
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Ng EST, Liew Y, Earnest A, Koh LP, Lim SW, Hsu LY. Audit of fluoroquinolone prophylaxis against chemotherapy-induced febrile neutropenia in a hospital with highly prevalent fluoroquinolone resistance. Leuk Lymphoma 2010; 52:131-3. [PMID: 20929324 DOI: 10.3109/10428194.2010.518655] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Antineoplastic Agents/adverse effects
- Bacteremia/drug therapy
- Bacteremia/etiology
- Bacteremia/pathology
- Cohort Studies
- Drug Resistance, Bacterial/drug effects
- Female
- Fluoroquinolones/therapeutic use
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neutropenia/chemically induced
- Neutropenia/prevention & control
- Prognosis
- Retrospective Studies
- Risk Factors
- Survival Rate
- Young Adult
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Ng EST, Liew Y, Koh LP, Hsu LY. Fluoroquinolone Prophylaxis Against Febrile Neutropenia in Areas With High Fluoroquinolone Resistance—An Asian Perspective. J Formos Med Assoc 2010; 109:624-31. [DOI: 10.1016/s0929-6646(10)60102-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/24/2010] [Accepted: 05/27/2010] [Indexed: 12/01/2022] Open
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Steensma DP, Stone RM. Practical Recommendations for Hypomethylating Agent Therapy of Patients With Myelodysplastic Syndromes. Hematol Oncol Clin North Am 2010; 24:389-406. [DOI: 10.1016/j.hoc.2010.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Chemotherapy-induced febrile neutropenia is costly in both financial and human terms. The associated costs can be reduced substantially through the development and implementation of national policies and locally agreed protocols for the prevention and management of febrile neutropenia. Patients, the NHS, healthcare professionals and the broader community all stand to benefit from a commitment to effective management of this common and predictable side effect of some chemotherapy regimens for early-stage breast cancer.
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Abstract
The advent of chemotherapy for early-stage breast cancer has ushered in a new age of management for the condition. This article charts the evolution of chemotherapy for breast cancer, and highlights the current need for carefully planned, fully implemented local protocols to support the delivery of modern regimens.
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Abstract
There is good evidence to suggest that dose intensity is important when considering the effectiveness of adjuvant chemotherapy in patients with breast cancer. However, the development of chemotherapy-induced febrile neutropenia can lead to reduction in dose intensity and other treatment modifications, which may negatively affect patient outcomes. Febrile neutropenia can be prevented by the use of primary prophylactic treatment, notably with granulocyte colony-stimulating factors. This practice is supported by international guidelines, all of which recommend that primary prophylaxis with granulocyte colony-stimulating factors should be used with chemotherapy where the risk of febrile neutropenia is 20% or greater.
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Affiliation(s)
- S Kelly
- Plymouth Oncology Centre, Derriford Hospital, Plymouth PL6 8DH, UK.
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50
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Abstract
Although the use of prophylactic granulocyte colony-stimulating factor (G-CSF) in conjunction with myelosuppressive chemotherapy is supported by clinical research evidence and advocated by international clinical guidelines when the consequent risk of febrile neutropenia exceeds 20%, there remains doubt as to the cost-effectiveness of the practice. There are limited economic data, and the data that are available are not necessarily applicable to the management of breast cancer in a European setting. Much of the available evidence on G-CSF in the management of febrile neutropenia is partial, focusing primarily on direct costs to the health service - that is, those related to hospitalisation and drug treatment. A full assessment of the cost effectiveness of G-CSF prophylaxis needs to take account of both costs and outcomes, including mortality, quality of life and patient functioning. As febrile neutropenia has been shown to affect productivity, consideration should also be given to quantifying the indirect costs of neutropenia.
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Affiliation(s)
- P Trueman
- York Health Economics Consortium, University of York, York YO10 5NH, UK.
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