1
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Mei Q, Li X, Wang R, Qin K, Cheng Y, Cheng W, Dong Y, He Z, Li J, Li M, Tang X, Wang X, Xiao X, Yang B, Zhou Y, Wang R, Huang Q, Hu G, Li J. Efficacy and Safety for the Use of Half-Dosed Pegylated Granulocyte Colony-Stimulating Factors in Preventing Febrile Neutropenia During Chemotherapy in Patients With Malignant Tumors: A Multicenter, Open-Labeled, Single-Arm Phase 2 Trial. Front Oncol 2022; 12:820324. [PMID: 35574371 PMCID: PMC9095430 DOI: 10.3389/fonc.2022.820324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prophylactic granulocyte-colony stimulating factor (G-CSF) has been shown to effectively prevent febrile neutropenia (FN) and grade 3/4 neutropenia during myelosuppressive treatment. The present study reports the clinical efficacy and safety of the prophylactic use of G-CSF with a half dose for cancer patients with an intermediate risk of FN combined with ≥1 patient-specific risk during multiple chemotherapy. Methods This multicenter, one-arm, and open-label clinical study involved 151 patients [median age, 54 years old (range, 46.0–62.5); 38.4% female] with malignant tumors, including >20 different cancers. These patients underwent a total of 604 cycles of chemotherapy and received a half dose of PEG-rhG-CSF administration prior to each cycle. Results The incidence rate of FN was 3.3% for this cohort during chemotherapy. Chemotherapy delay occurred in 6 (4.0%) patients for 12 (2.0%) cycles. Early termination of cancer treatment occurred in 14 (9.3%) patients. In this cohort, 23 (15.2%) patients required antibiotic use during courses of chemotherapy. A total of 28 (18.5%) patients experienced clear adverse effects during cancer treatment. Conclusion The prophylactic PEG-rhG-CSF with a half dose can both efficaciously and safely prevent neutropenia for patients of diverse cancers with an intermediate risk of FN combined with ≥1 patient-specific risk during chemotherapy.
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Affiliation(s)
- Qi Mei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Xiaoyu Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Runkun Wang
- Department of Oncology, the First People's Hospital of Guangshui, Hubei, China
| | - Kai Qin
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yi Cheng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Weiting Cheng
- Department of Oncology, Wuhan No. 1 Hospital, Wuhan, China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Affiliated Hospital of Hubei University of Medicine, Hubei, China
| | - Zhen He
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan, China
| | - Jun Li
- Department of Oncology, Xiaogan Central Hospital, Xiaogan, China
| | - Ming Li
- Department of Oncology, Wuhan Pulmonary Hospital, Wuhan, China
| | - Xi Tang
- Department of Oncology, Jingzhou Central Hospital, Hubei, China
| | - Xudong Wang
- Department of Oncology, Huangshi Central Hospital, Huangshi, China
| | - Xuxuan Xiao
- Department of Oncology, Wuhan No. 1 Hospital, Wuhan, China
| | - Bin Yang
- Department of Oncology, Hubei Cancer Hospital, TongJi Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yajuan Zhou
- Department of Radiation Oncology, Hubei Cancer Hospital, TongJi Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Rui Wang
- Department of Oncology, Wuhan No. 1 Hospital, Wuhan, China
| | - Qiao Huang
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Guangyuan Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jian Li
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
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2
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Li S, Huang J, Guo Y, Wang J, Lu S, Wang B, Gong Y, Qin S, Zhao S, Wang S, Liu Y, Fang Y, Guo Y, Xu Z, Ulloa L. PAC1 Receptor Mediates Electroacupuncture-Induced Neuro and Immune Protection During Cisplatin Chemotherapy. Front Immunol 2021; 12:714244. [PMID: 34552585 PMCID: PMC8450570 DOI: 10.3389/fimmu.2021.714244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023] Open
Abstract
Platinum-based chemotherapy is an effective treatment used in multiple tumor treatments, but produces severe side effects including neurotoxicity, anemia, and immunosuppression, which limits its anti-tumor efficacy and increases the risk of infections. Electroacupuncture (EA) is often used to ameliorate these side effects, but its mechanism is unknown. Here, we report that EA on ST36 and SP6 prevents cisplatin-induced neurotoxicity and immunosuppression. EA induces neuroprotection, prevents pain-related neurotoxicity, preserves bone marrow (BM) hematopoiesis, and peripheral levels of leukocytes. EA activates sympathetic BM terminals to release pituitary adenylate cyclase activating polypeptide (PACAP). PACAP-receptor PAC1-antagonists abrogate the effects of EA, whereas PAC1-agonists mimic EA, prevent neurotoxicity, immunosuppression, and preserve BM hematopoiesis during cisplatin chemotherapy. Our results indicate that PAC1-agonists may provide therapeutic advantages during chemotherapy to treat patients with advanced neurotoxicity or neuropathies limiting EA efficacy.
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Affiliation(s)
- Shanshan Li
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin Huang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jiaqi Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shanshan Lu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bin Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yinan Gong
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Siru Qin
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Suhong Zhao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shenjun Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yangyang Liu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuxin Fang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongming Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhifang Xu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Luis Ulloa
- Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University, Durham, NC, United States
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3
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Klein EM, Sauer S, Klein S, Tichy D, Benner A, Bertsch U, Brandt J, Kimmich C, Goldschmidt H, Müller-Tidow C, Jordan K, Giesen N. Antibiotic Prophylaxis or Granulocyte-Colony Stimulating Factor Support in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation. Cancers (Basel) 2021; 13:3439. [PMID: 34298654 PMCID: PMC8303829 DOI: 10.3390/cancers13143439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
We compare, in this manuscript, antibiotic prophylaxis versus granulocyte-colony stimulating factor (G-CSF) support as anti-infective strategies, in patients with multiple myeloma (MM), undergoing high-dose therapy followed by autologous stem cell transplantation (HDT/ASCT). At our institution, antibiotic prophylaxis after HDT/ASCT in MM was stopped in January 2017 and replaced by G-CSF support in March 2017. Consecutive MM patients who received HDT/ASCT between March 2016 and July 2018 were included in this single-center retrospective analysis. In total, 298 patients and 353 individual cases of HDT/ASCT were evaluated. In multivariate analyses, G-CSF support was associated with a significantly shortened duration of severe leukopenia < 1/nL (p < 0.001, hazard ratio (HR) = 16.22), and hospitalization (estimate = -0.19, p < 0.001) compared to antibiotic prophylaxis. Rates of febrile neutropenia, need of antimicrobial therapy, transfer to intensive care unit, and death, were similar between the two groups. Furthermore, antibiotic prophylaxis was associated with a significantly increased risk for the development of multidrug resistant bacteria especially vancomycin-resistant Enterococcus faecium compared to G-CSF support (odds ratio (OR) = 17.38, p = 0.01). Stop of antibiotic prophylaxis as an anti-infective strategy was associated with a reduction in overall resistance rates of bacterial isolates. These results indicate that G-CSF support should be the preferred option in MM patients undergoing HDT/ASCT.
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Affiliation(s)
- Eva-Maria Klein
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Internal Medicine 5, Klinikum Nuremberg, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Sandra Sauer
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Diana Tichy
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Uta Bertsch
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Juliane Brandt
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Christoph Kimmich
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
- National Center for Tumor Diseases, 69120 Heidelberg, Germany
| | - Karin Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Nicola Giesen
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany
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4
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Classen AY, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff LD, Alakel N, Christopeit M, Krause SW, Mayer K, Neumann S, Cornely OA, Penack O, Weißinger F, Wolf HH, Vehreschild JJ. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol 2021; 100:1603-1620. [PMID: 33846857 PMCID: PMC8116237 DOI: 10.1007/s00277-021-04452-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.
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Affiliation(s)
- Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Georg Maschmeyer
- Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Luisa Durán Graeff
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan W Krause
- Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Silke Neumann
- Interdisciplinary Center for Oncology, Wolfsburg, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Olaf Penack
- Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Weißinger
- Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Jörg Janne Vehreschild
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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5
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Fernandes R, Mazzarello S, Stober C, Ibrahim MF, Dudani S, Perdrizet K, Majeed H, Vandermeer L, Shorr R, Hutton B, Fergusson D, Gyawali B, Clemons M. Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review. J Glob Oncol 2018; 4:1-8. [PMID: 30241156 PMCID: PMC6180804 DOI: 10.1200/jgo.2016.008540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite widespread use of fluorouracil, epirubicin, cyclophosphamide, docetaxel (FEC-D) chemotherapy in breast cancer, the optimal strategy for primary febrile neutropenia (FN) prophylaxis remains unknown. A systematic review was therefore performed. METHODS Embase, Ovid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, and conference proceedings were searched from 1946 to April 2016 for trials that reported the effectiveness of primary FN prophylaxis with FEC-D chemotherapy. Outcome measures were incidence of FN; treatment-related hospitalizations; chemotherapy dose delays, reductions, and discontinuations; and adverse events from prophylaxis. RESULTS Of 2,205 identified citations, eight studies (n = 1,250) met our eligibility criteria. Three additional studies (n = 293) were identified from a prior systematic review. Three randomized controlled trials (n = 576), one phase IV single-arm trial (n = 69), one prospective observational study (n = 37), and six retrospective studies (n = 861) were identified. Agents investigated were pegfilgrastim (n = 108), filgrastim (n = 1,119), and ciprofloxacin (n = 89). The heterogeneity of studies meant that a narrative synthesis of results was performed. Median FN rates for patients who received FEC-D with and without primary prophylaxis were 10.1% (interquartile range [IQR], 3.9% to 22.6%) and 23.9% (IQR, 9.2% to 27.3%), respectively. In the absence of primary prophylaxis, FN was more common during docetaxel than during FEC. Data from six studies showed a median rate of dose reductions and delays of 6.1% (IQR, 3.1% to 14.3%) and 19.3% (IQR, 10.5% to 32.8%), respectively, that occurred as a consequence of FN. Toxicity from prophylaxis itself was rarely reported. CONCLUSION Primary FN prophylaxis is effective in patients who receive FEC-D chemotherapy. The paucity of prospective data makes optimal recommendations about the choice and timing of prophylaxis challenging.
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Affiliation(s)
- Ricardo Fernandes
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Sasha Mazzarello
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Carol Stober
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Mohamed F.K. Ibrahim
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Shaan Dudani
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Kirstin Perdrizet
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Habeeb Majeed
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Lisa Vandermeer
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Risa Shorr
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Brian Hutton
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Dean Fergusson
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Bishal Gyawali
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Mark Clemons
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
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6
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Klein K, de Haas V, Kaspers GJL. Clinical challenges in de novo pediatric acute myeloid leukemia. Expert Rev Anticancer Ther 2018; 18:277-293. [DOI: 10.1080/14737140.2018.1428091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Klein
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Valérie de Haas
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Dutch Childhood Oncology Group, The Hague, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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7
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Abstract
Bacterial pneumonias exact unacceptable morbidity on patients with cancer. Although the risk is often most pronounced among patients with treatment-induced cytopenias, the numerous contributors to life-threatening pneumonias in cancer populations range from derangements of lung architecture and swallow function to complex immune defects associated with cytotoxic therapies and graft-versus-host disease. These structural and immunologic abnormalities often make the diagnosis of pneumonia challenging in patients with cancer and impact the composition and duration of therapy. This article addresses host factors that contribute to pneumonia susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of bacterial pneumonia in patients with cancer.
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Affiliation(s)
- Justin L Wong
- Division of Internal Medicine, Department of Pulmonary, Critical Care and Sleep Medicine, The University of Texas Health Sciences Center, 6431 Fannin Street, MSB 1.434, Houston, TX 77030, USA
| | - Scott E Evans
- Division of Internal Medicine, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1100, Houston, TX 77030, USA.
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8
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Young AY, Leiva Juarez MM, Evans SE. Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation. Clin Chest Med 2017; 38:479-491. [PMID: 28797490 DOI: 10.1016/j.ccm.2017.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fungal pneumonias cause unacceptable morbidity among patients with hematologic malignancies (HM) and recipients of hematopoietic stem cell transplantation (HSCT). The high incidence of fungal pneumonias in HM/HSCT populations arises from their frequently severe, complex, and persistent immune dysfunction caused by the underlying disease and its treatment. The cytopenias, treatment toxicities, and other immune derangements that make patients susceptible to fungal pneumonia frequently complicate its diagnosis and increase the intensity and duration of antifungal therapy. This article addresses the host factors that contribute to susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of fungal pneumonia in patients with HM/HSCT.
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Affiliation(s)
- Alisha Y Young
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Texas Health Sciences Center, 6431 Fannin Street, MSB 1.434, Houston, TX 77030, USA
| | - Miguel M Leiva Juarez
- Division of Internal Medicine, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1100, Houston, TX 77030, USA
| | - Scott E Evans
- Division of Internal Medicine, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1100, Houston, TX 77030, USA.
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9
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Conn JR, Catchpoole EM, Runnegar N, Mapp SJ, Markey KA. Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection. PLoS One 2017; 12:e0178059. [PMID: 28542412 PMCID: PMC5438184 DOI: 10.1371/journal.pone.0178059] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/08/2017] [Indexed: 02/03/2023] Open
Abstract
Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a “real world” cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period. In this cohort, the 30-day mortality following confirmed blood stream infection (BSI) was 5.9%, which is lower than most reports in the recent literature. We compared the blood culture results of inpatients undergoing induction chemotherapy and outpatients presenting with fevers and found a significantly higher rate of proven BSI in the outpatient group. In all settings, gram-negative organisms were most common. The rate of resistance to first-line empiric antibiotics among pathogenic isolates was 11.6% in the whole cohort, independent of blood culture circumstances. There was a trend to higher resistance rates among inpatients undergoing induction chemotherapy compared to patients presenting to the emergency department (17.4% vs 7.5%) but this did not reach statistical significance. We also report low rates of ciprofloxacin resistance (5% of isolates), in a center where universal fluoroquinolone prophylaxis is not employed. Our low resistance and mortality rates support our current therapeutic strategies, however presence of resistant organisms across the spectrum of indications for BC collection highlights the importance of surveilling local patterns, escalating antimicrobial therapy in the deteriorating patient, and considering advanced techniques for the rapid identification of resistance in this patient population.
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Affiliation(s)
- Jason R. Conn
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Naomi Runnegar
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sally J. Mapp
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Kate A. Markey
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Haematology and Bone Marrow Transplantation Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
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