The efficacy and safety of oral levofloxacin therapy for overall infection prophylaxis in cancer patients with neutropenia in outpatient settings.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18681-e18681
Author(s):  
Lilia Davenport ◽  
Jamie Chin ◽  
Sharon Blum ◽  
Meredith Akerman
Keyword(s):  
Febrile Neutropenia ◽  
Risk Group ◽  
Infection Risk ◽  
Hospitalized Patients ◽  
Fluoroquinolone Resistance ◽  
Infection Prophylaxis ◽  
Chemotherapy Treatment ◽  
Safety Outcome ◽  
Bacterial Cultures ◽  
Levofloxacin Prophylaxis

e18681 Background: Patients undergoing chemotherapy treatment are at risk for bacterial infection during their period of neutropenia. However, not all neutropenic patients are at high risk for developing infection. The purpose of this study was to evaluate the efficacy and safety of prophylactic oral levofloxacin in high, intermediate, and low infection risk patients with cancer in the ambulatory care setting. Methods: This was a retrospective chart review of 100 cancer patients with high, intermediate, and low overall infection risk who were prescribed outpatient oral levofloxacin prophylaxis between October 2019 and July 2020. This quality improvement project included adults with a history of malignancy and presence of neutropenia who have received chemotherapy treatment and oral levofloxacin therapy for overall infection prophylaxis. The primary efficacy outcome was the rate of hospital admission due to febrile neutropenia. The primary safety outcome was the occurrence of side effects of levofloxacin therapy. Secondary outcomes evaluated the duration of levofloxacin therapy, the rate of fluoroquinolone resistance in positive bacterial cultures, progression to sepsis in hospitalized patients and the rate of death due to mult-idrug resistance including fluoroquinolones. Results: Hospital admission due to febrile neutropenia after a chemotherapy cycle occurred in 18% of patients prescribed levofloxacin. Among hospitalized patients due to febrile neutropenia, 2% had low to intermediate overall infection risk and 16% had high overall infection risk. The primary safety outcome occurred in 25% of patients. The incidence of QTc prolongation occurred in 8% of patients; dermatologic side effects occurred in 9% of patients; the rate of Clostridioides difficile infection was 6%, and the rate of tendon rupture was 2%. Median duration of levofloxacin prophylaxis in the low overall infection risk group was 7 days, compared to the intermediate overall infection risk group (8.5 days) and the high overall infection risk group (14 days) with Kruskal-Wallis test p-value of 0.0009. The rate of fluoroquinolone resistance in positive bacterial cultures was 10%. Progression to sepsis in hospitalized patients occurred in 17% of patients. The rate of death due to multi-drug resistance including fluoroquinolone was 2%. Conclusions: Our findings signify preserved efficacy of levofloxacin prophylaxis in the ambulatory setting. Our findings should be considered to develop rational strategies to reduce fluoroquinolone overprescribing or limit duration of levofloxacin prophylaxis. If patients present with solid tumors and experience neutropenia, the use of antibacterial prophylaxis is not recommended because in general, patients recover from neutropenia quickly.

scholarly journals A novel signature of two long non-coding RNAs in BRCA mutant ovarian cancer to predict prognosis and efficiency of chemotherapy

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Yinglian Pan ◽  
Li Ping Jia ◽  
Yuzhu Liu ◽  
Yiyu Han ◽  
Qian Li ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Risk Group ◽  
Gynecologic Cancer ◽  
High Risk Group ◽  
Low Risk ◽  
The Cancer Genome Atlas ◽  
Chemotherapy Treatment ◽  
Prognostic Signature

Abstract Background In this study we aimed to identify a prognostic signature in BRCA1/2 mutations to predict disease progression and the efficiency of chemotherapy ovarian cancer (OV), the second most common cause of death from gynecologic cancer in women worldwide. Methods Univariate Cox proportional-hazards and multivariate Cox regression analyses were used to identifying prognostic factors from data obtained from The Cancer Genome Atlas (TCGA) database. The area under the curve of the receiver operating characteristic curve was assessed, and the sensitivity and specificity of the prediction model were determined. Results A signature consisting of two long noncoding RNAs(lncRNAs), Z98885.2 and AC011601.1, was selected as the basis for classifying patients into high and low-risk groups (median survival: 7.2 years vs. 2.3 years). The three-year overall survival (OS) rates for the high- and low-risk group were approximately 38 and 100%, respectively. Chemotherapy treatment survival rates indicated that the high-risk group had significantly lower OS rates with adjuvant chemotherapy than the low-risk group. The one-, three-, and five-year OS were 100, 40, and 15% respectively in the high-risk group. The survival rate of the high-risk group declined rapidly after 2 years of OV chemotherapy treatment. Multivariate Cox regression associated with other traditional clinical factors showed that the 2-lncRNA model could be used as an independent OV prognostic factor. Analyses of data from the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) indicated that these signatures are pivotal to cancer development. Conclusion In conclusion, Z98885.2 and AC011601.1 comprise a novel prognostic signature for OV patients with BRCA1/2 mutations, and can be used to predict prognosis and the efficiency of chemotherapy.

Chronic Comorbidities and Chemotherapy-Induced Febrile Neutropenia in Patients with Non-Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3671-3671
Author(s):  
Chun Chao ◽  
John H Page ◽  
Roberto Rodriguez ◽  
Su-Jau Yang ◽  
Julie Huynh ◽  
...  
Keyword(s):  
Propensity Score ◽  
Febrile Neutropenia ◽  
Research Funding ◽  
Chemotherapy Regimen ◽  
Patient Characteristics ◽  
Chemotherapy Cycle ◽  
Cancer Stage ◽  
Chemotherapy Treatment ◽  
Non Hodgkin Lymphoma ◽  
Chronic Comorbidities

Abstract Abstract 3671 Background: Chemotherapy induced febrile neutropenia (FN) is a clinically important adverse event as it can impact patient survival by delaying or reducing chemotherapy dose administered. Clinical guidelines recommend granulocyte-colony stimulating factors (G-CSF) be used in cancer patients when febrile neutropenia (FN) risk is >20%. Although the myelotoxicity of the chemotherapy regimen is a key determinant of FN risk, it is now recognized that patient characteristics may increase this risk further. We conducted a retrospective cohort study to evaluate the association of chronic comorbidities to FN in patients with non-Hodgkin lymphoma (NHL). Methods: Incident NHL cases diagnosed between 2000–2009 who received chemotherapy within 12 months of cancer diagnosis were identified from Kaiser Permanente Southern California, a large managed care organization. Those who had prophylactic G-CSFs, dose-dense chemotherapy or bone marrow transplant were excluded. Comorbidities of interest included cardiovascular, liver, renal, metabolic and autoimmune disorders, anemia, previous cancer and HIV infection. History of comorbidity of interest were assessed in the 12 months prior to NHL diagnosis, and identified by ICD-9 codes or disease registries. FN was assessed only in the first chemotherapy cycle, and identified by absolute neutrophil count (ANC), ICD-9 codes for neutropenia and fever, or hospitalization with bacterial/fungal infection. Patients were followed from their first chemotherapy treatment to the start of the second cycle, death or day 28, whichever came first. Logistic regression was used to estimate the propensity score for each comorbidity; these propensity scores included patient characteristics and other comorbidities as covariates. Each comorbidity and propensity score were included in Cox models to determine associations between comorbidities and FN. We also evaluated models that additionally adjusted for cancer stage, baseline ANC, chemotherapy regimen, dose reduction, and radiation treatment prior to chemotherapy. Results: A total of 2,480 NHL patients who received chemotherapy were included. The mean age was 63.3 years. Fifty-five percent of the cases were male, and the majority of the cases were of white race (65.6%). Sixty percent of the cases received CHOP or R-CHOP. There were 236 (9.5%) patients that had FN in the first chemotherapy cycle. Anemia [adjusted hazard ratio adjusted (HR) =1.6, 95% CI, 1.2–2.2], HIV infection [HR=3.0, 95% CI 1.6–5.3], AIDS [HR=2.4, 95% CI 1.2–4.6], and rheumatoid diseases [HR=2.1, 95% CI 1.2–3.6] were all associated with a statistically significantly increased FN risk (Table 1). In addition, peptic ulcer disease, renal disease and connective tissue disease were also associated with risk of FN, although these associations were not statistically significant. HR estimates did not change materially after also adjusting for cancer stage, ANC, chemotherapy regimen, dose reduction and radiation therapy prior to chemotherapy in the Cox model. Conclusions: Our findings suggest that several chronic comorbidities may be associated with increased FN risk in the first chemotherapy cycle among NHL patients not already receiving prophylactic G-CSFs. This information, if confirmed by others, may aid clinical decision making with respect to use of prophylactic G-CSF use during chemotherapy treatment. Disclosures: Chao: Amgen,Inc: Research Funding. Page:Amgen, Inc: Employment, Shareholder Other. Rodriguez:Amgen, Inc: Research Funding. Yang:Amgen, Inc: Research Funding. Huynh:Amgen, Inc: Research Funding. Chia:Amgen, Inc: Employment, Shareholder Other.

Audit of fluoroquinolone prophylaxis against chemotherapy-induced febrile neutropenia in a hospital with highly prevalent fluoroquinolone resistance

2010 ◽  
Vol 52 (1) ◽  
pp. 131-133 ◽  
Author(s):  
Esther Shu-Ting Ng ◽  
Yixin Liew ◽  
Arul Earnest ◽  
Liang Piu Koh ◽  
Siew-Woon Lim ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Fluoroquinolone Resistance ◽  
Fluoroquinolone Prophylaxis

scholarly journals Predicting Neutropenia Risk in Breast Cancer Patients from Pre- Chemotherapy Characteristics

2014 ◽  
Vol 8 (1) ◽  
pp. 16-21
Author(s):  
Sodiq Lawal ◽  
Michael J. Korenberg ◽  
Natalia Pittman ◽  
Mihaela Mates
Keyword(s):  
Breast Cancer ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Correlation Coefficient ◽  
Tumor Size ◽  
Odds Ratio ◽  
Risk Group ◽  
High Risk Group ◽  
Breast Cancer Patients ◽  
Computing Device

A previous study (Pittman, Hopman, Mates) of breast cancer patients undergoing curative chemotherapy (CT) found that the third most common reason for emergency department (ER) visits and hospital admission (HA) was febrile neutropenia. Factors associated with ER visits and HA included (1) stage of the cancer, (2) size of tumor, (3) adjuvant versus neo-adjuvant CT (“adjuvance”), and (4) number of CT cycles. We hypothesized that a statistically-significant predictor of neutropenia could be built based on some of these factors, so that risk of neutropenia predicted for a patient feeling unwell during CT could be used in weighing need to visit the ER. The number of CT cycles was not used as a factor so that the predictor could calculate the neutropenia risk for a patient before the first CT cycle. Different models were built corresponding to different pre-chemotherapy factors or combinations of factors. The single factor yielding the best classification accuracy was tumor size (Mathews’ correlation coefficient φ = +0.18, Fisher’s exact two-tailed probability P < 0.0374). The odds ratio of developing febrile neutropenia for the predicted high-risk group compared to the predicted low-risk group was 5.1875. Combining tumor size with adjuvance yielded a slightly more accurate predictor (Mathews’ correlation coefficient φ = +0.19, Fisher’s exact two-tailed probability P < 0.0331, odds ratio = 5.5093). Based on the observed odds ratios, we conclude that a simple predictor of neutropenia may have value in deciding whether to recommend an ER visit. The predictor is sufficiently fast that it can run conveniently as an Applet on a mobile computing device.

Overall survival and complications of cancer therapy in HIV-positive cancer patients on HAART compared to HIV-negative cancer patients.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 276-276
Author(s):  
Kelly Ann Fritz ◽  
David D. Stenehjem ◽  
Stephanie A. Sanders ◽  
Adam Louis Cohen
Keyword(s):  
Overall Survival ◽  
Cancer Therapy ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Patient Population ◽  
Hiv Positive ◽  
Cancer Type ◽  
Infection Prophylaxis ◽  
Hiv Negative

276 Background: HIV-positive patients are living longer and are at higher risk for any type of cancer, not only traditional AIDS-defining cancers (ADC). This study aims to assess our overall survival rate in HIV-positive cancer patients compared to HIV-negative patients, and identify differences in complications of cancer therapy in order to ensure quality of care and outcomes in this patient population. Methods: HIV-positive patients ≥ 18 years of age with a diagnosis of cancer in the Huntsman Cancer Institute Tumor Registry from 2008-2013 were matched to HIV-negative cancer patients by cancer type, stage, age, and sex. Overall survival (OS), admission for febrile neutropenia (FN), total hospital length (LOS) of stay for any reason, and the total number of blood transfusions were assessed. Kaplan-Meier methodology was used to assess differences in cancer survival. Results: A total of 55 HIV-positive patients and 40 HIV-negative patients were included. HIV-positive patients were younger at cancer diagnosis than HIV-negative patients, 50 vs. 56 years old (p = 0.0017). A trend for reduced median OS in HIV-positive patients was observed compared to HIV-negative patients (HR 1.81; 95% CI 0.77-4.71; p = 0.1835). One-year OS was 78% for HIV-positive vs 88% for HIV-negative patients (p = 0.2673). Numerically an increased mean number of hospital admissions for FN (0.7 ± 2.0 vs. 0.4 ± 1.3; p = 0.2663), transfusions (2.5 ± 12.7 vs. 0.9 ± 2.5; p = 0.4907), and inpatient LOS (12.7 ± 23.6 vs. 7.0 ± 13.0; p = 0.2381) were observed in the HIV-positive group compared to the HIV-negative group, however this did not meet statistical significance. Conclusions: This retrospective study highlights a trend for a reduction in survival and increased FN admissions, LOS and transfusion requirements in HIV-positive patients with cancer. We have identified a need for improvement in supportive care treatments such as primary febrile neutropenia prophylaxis, opportunistic infection prophylaxis, and anemia management to improve the quality of cancer treatment in this patient population.

A breakthrough in treatment of cancer patients with grade 4/profound febrile neutropenia.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14513-e14513
Author(s):  
Calin Ioan Cainap ◽  
Simona Sorana Cainap ◽  
Sanziana Cetean- Gheorghe ◽  
Daniel Corneliu Leucuta ◽  
Ovidiu Vasile Bochis ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Protein C ◽  
Severe Renal Impairment ◽  
Chemotherapy Treatment ◽  
Reactive Protein ◽  
Myeloablative Chemotherapy ◽  
Hospitalised Patients ◽  
Life Threatening ◽  
History Of ◽  
Time Of Administration

e14513 Background: febrile neutropenia (FN) remains one of the most serious side effects of chemotherapy treatment, which is life-threatening. Late consequence of FN is dose reduction and delaying of therapies. Actual guidelines allows granulocyte-colony-stimulating factors (G-CSF) in management of profound FN in addition to antibiotics and supportive care Methods: it is an original prospective study, approved by local ethics comitee, which included 73 patients with confirmed malignancy, treated in our Institute with chemotherapy, who developed febrile neutropenia (FN) and were hospitalised. Patients with myeloablative chemotherapy and bone marrow transplantation support, severe renal impairment, abnormal liver function or with a history of allergic reactions to the antibiotics were excluded from the study. There were recorded 96 episodes of grade 4 FN (1-3 episodes / patients). Each of one was hospitalised according to institutional guideline but with a dose of G-CSF of 16 µg/Kg/day i.v. continous infusion Results: median age of included patients was 59 years, with approximately 48 % male and 52% female, whithout significance in terms of recovery from FN (p = 1.00). 30% of the patients had prophilactic G-CSF administrated, but not significant for recovery from aplasia for included patients (p = 0.34). Median chemotherapy line responsible for FN was 2, and median cycle which produced FN was 3. Median level of neutrophiles (PMN) 450/mm3 and leucocytes (WBC) 1875/ mm3 at time of FN, 10 patients being in profound FN (PMN < 100/mm3). Median time to recovery was 25.5 hours for 72 included patients, with 1 patient dead whithout recovery. Predictive factors for shortened recovery were lower levels of reactive protein C (p < 0.001) and procalcitonine (p = 0.002) and higher WBC (p = 0.006) and PMN (p < 0.001) at time of administration of responsible chemotherapy regimen for FN. The earlier cycle responsible, between a line of chemotherapy, for FN, the better chance for patient to have shortened duration of FN (p < 0.0001). Conclusions: continous i.v. administration of G-CSF could represents a very effective alternative for patients with profound febrile neutropenia, with the shortest ever reported interval for neutrophiles recovery

Modeling the Cost Effectiveness of Secondary Febrile Neutropenia Prophylaxis During Standard-Dose Chemotherapy

2008 ◽  
Vol 26 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Johanna N.H. Timmer-Bonte ◽  
Eddy M.M. Adang ◽  
Evelien Termeer ◽  
Johan L. Severens ◽  
Vivianne C.G. Tjan-Heijnen
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
The Netherlands ◽  
Febrile Neutropenia ◽  
Economic Analysis ◽  
Standard Dose ◽  
The United States ◽  
Secondary Prophylaxis ◽  
Infection Prophylaxis ◽  
Data Set

Purpose Current guidelines (ie, by the American Society of Clinical Oncology and the European Organisation for Research and Treatment of Cancer) do not recommend secondary infection prophylaxis, whereas, in contrast, caregivers prefer secondary prophylaxis to chemotherapy dose reduction after an episode of febrile neutropenia (FN). Because granulocyte colony-stimulating factor (G-CSF) is expensive, this study investigates the economic consequences of secondary prophylactic use of different prophylactic strategies (antibiotics, antibiotics plus G-CSF, and a combined sequential approach) in a population at risk of FN, using a Markov model. Methods The input for the model is mainly based on the clinical outcome and patient-based cost data set (adopting the health care payer's perspective for the Netherlands) derived from a randomized study on primary prophylaxis in small-cell lung cancer (SCLC) patients; establishing mean cost of an episode FN of €3,290 and prophylaxis of €79 (antibiotics) ± €1,616 (G-CSF) per cycle. The economic analysis was analyzed probabilistically using first- and second-order Monte Carlo simulation. The incremental cost-effectiveness ratio (ICER) was defined as cost per FN-free cycle. Results Secondary prophylaxis with antibiotics was the least expensive strategy (mean, €4,496/patient). The strategy antibiotics plus G-CSF was most expensive (mean, € 8,998/patient). Comparison of these two strategies resulted in an unacceptably high ICER (€343,110 per FN-free cycle) in the Dutch context. In scenarios using higher FN-related costs (as found in the United States), the strategies are less distinct in their monetary effects, but still favor antibiotics. Conclusion This model-based economic analysis demonstrates that in the Netherlands and most likely also in the United States, if secondary prophylaxis is preferred, the strategy with antibiotics is recommended.

scholarly journals The Prevalence of Fluoroquinolone Resistance Mechanisms in ColonizingEscherichia coliIsolates Recovered from Hospitalized Patients

2010 ◽  
Vol 51 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Joshua P. Metlay ◽  
Xiangqun Mao ◽  
Xiaoyan Han ◽  
Neil O. Fishman ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Hospitalized Patients ◽  
Fluoroquinolone Resistance

Impact of a cefepime shortage on dosing regimens and outcomes in hospitalized adults with febrile neutropenia

2020 ◽  
pp. 107815522091863
Author(s):  
Manuela Haiduc ◽  
Monank Patel ◽  
Thomas L Walsh ◽  
Matthew A Moffa ◽  
Derek N Bremmer
Keyword(s):  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Severity Of Illness ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Hospitalized Patients ◽  
Dosing Regimen ◽  
United States Food ◽  
Dosing Regimens

Background Drug shortages may negatively impact outcomes in hospitalized patients. A cefepime dosing regimen of 1 gram every 6 hours (1 g q6h) has shown to provide similar exposures above target minimum inhibitory concentrations compared to the regimen of 2 g q8h approved by the United States Food and Drug Administration (FDA) for febrile neutropenia. Our objective was to determine if the dosing regimen of 1 g q6h amidst a cefepime shortage is an appropriate alternative for the treatment of febrile neutropenia. Methods A retrospective chart review of hospitalized patients who received cefepime for febrile neutropenia over a two-year period was performed. Patients were grouped based on cefepime dosing strategy: 2 g q8h vs. 1 g q6h. The primary objective was to compare time to defervescence after cefepime initiation. Secondary objectives included all-cause 30-day mortality, duration of antibiotic therapy, and inpatient length of stay. Results Seventy-five patients in each arm were included. There were no differences in baseline age or severity of illness between groups. There was no difference in the primary objective as median time to defervescence was similar between the 2 g q8h and 1 g q6h groups (69.0 vs. 65.3 h: p= 0.67). Additionally, no differences were found in the secondary objectives of all-cause 30-day mortality (10.7% vs. 9.3%: p = 0.79), duration of therapy (80.8 vs. 88.0 h: p = 0.34), or length of stay (9 vs. 7 days: p = 0.50). Conclusions Our study identified no differences in clinical outcomes with cefepime 1 g q6h compared to the traditional FDA-approved 2 g q8h regimen for the treatment of febrile neutropenia.

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