Itraconazole Prophylaxis for Invasive Gingival Aspergillosis in Neutropenic Patients With Acute Leukemia

2002 ◽  
Vol 73 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Yoshinari Myoken ◽  
Tatsumi Sugata ◽  
Tai-ichi Kyo ◽  
Megumu Fujihara ◽  
Yuzuru Mikami
Keyword(s):  
Acute Leukemia ◽  
Neutropenic Patients

scholarly journals Granulocyte transfusions: current status

Blood ◽  
1980 ◽  
Vol 55 (1) ◽  
pp. 2-8 ◽  
Author(s):  
DJ Higby ◽  
D Burnett
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Clinical Medicine ◽  
Bone Marrow Failure ◽  
Current Status ◽  
Granulocyte Transfusion ◽  
Transfusion Therapy ◽  
Neutropenic Patients ◽  
Ongoing Evaluation ◽  
Made In

Abstract Since granulocyte transfusions first became widely used in clinical medicine, there have been advances in the treatment of acute leukemia and improvement in prevention and management of infection in neutropenic patients. Improved understanding now exists concerning prognosis of infections in such patients, and advances have been made in procurement of granulocytes. Granulocyte transfusions should be given for specific indications, and used adjunctively to other established antiinfective therapy. Once initiated, transfusions should be given in adequate doses at daily intervals (at least) with ongoing evaluation and periodic reassessment of the whole antiinfective program. Serious complications of granulocyte transfusion therapy are relatively rare, but the physician should be prepared to manage them intelligently. Research continues in discerning exactly how granulocyte transfusion work, in preservation of granulocytes, and in delineation of immunologic phenomena affecting the efficiacy of such therapy. Granulocyte transfusions will continue to be important in the management of acute leukemia, and other reversible bone marrow failure states, and in marrow transplantation and autotransplantation.

scholarly journals Pilot Study on Septifast PCR for the Early Diagnosis of Invasive Fungal Infections in Neutropenic Patients with Acute Leukemia

2008 ◽  
Vol 12 ◽  
pp. S32
Author(s):  
Frederic Lamoth ◽  
Katia Jaton-Ogay ◽  
Jacques Bille ◽  
Guy Prodhom ◽  
Laurence Senn ◽  
...  
Keyword(s):  
Pilot Study ◽  
Early Diagnosis ◽  
Acute Leukemia ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Neutropenic Patients

scholarly journals Levofloxacin prophylaxis to prevent bacterial infection in chemotherapy-induced neutropenia in acute leukemia

2010 ◽  
Vol 35 (3) ◽  
pp. 91-94 ◽  
Author(s):  
M. Mizanur Rahman ◽  
Mohiuddin Ahmed Khan
Keyword(s):  
Placebo Group ◽  
Acute Leukemia ◽  
Bacterial Infection ◽  
Antibiotic Prophylaxis ◽  
Bacterial Infections ◽  
Pathogenic Bacteria ◽  
Number Of Patients ◽  
Neutropenic Patients ◽  
Chemotherapy Induced Neutropenia ◽  
Levofloxacin Prophylaxis

Infection in chemotherapy-induced neutropenia (neutrophils <500/mm3) is the main cause of death during the treatment of acute leukemia. Antibiotic prophylaxis is a controversial issue to prevent or delay this infection. This study assessed the efficacy of prophylaxis with oral levofloxacin in chemotherapy-induced febrile neutropenic patients. Eighty patients of acute leukemia was randomly assigned to had levofoxacin (500 mg/daily) or placebo from the starting of chemotherapy. Out of 80 patients 53 developed neutropenia and fever. The number of patients with fever (78% vs. 68%), isolation of the pathogenic bacteria (30.43% vs. 16%) was higher and mean starting day of the fever (11.1 vs. 13.2) was shorter in the placebo group than the levofloxacin group. Levofloxacin reduced the bacterial infections and delays the onset of fever in chemotherapy-induced neutropenia especially in short duration (<7 days). Keywords: Chemotherapy; Leukemia; Levofloxacin; NeutropeniaOnline: 8 Feb 2010DOI: http://dx.doi.org/10.3329/bmrcb.v35i3.4130 Bangladesh Med Res Counc Bull 2009; 35: 91-94

scholarly journals Sepsis in Patients with Febrile Neutropenia: A Clinical and Autopsy-Based Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4622-4622
Author(s):  
Thamires Branco Da Silva ◽  
Guilherme Rossi Assis de Mendonça ◽  
Maiara Marx Luz Fiusa ◽  
Brunna Eulalio Alves ◽  
Rodolfo Monteiro Enz Hubert ◽  
...  
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Acute Leukemia ◽  
Organ Dysfunction ◽  
Tissue Damage ◽  
Blood Cultures ◽  
Severe Neutropenia ◽  
Histological Findings ◽  
Neutropenic Patients ◽  
Kidney Liver

Abstract Introduction: Sepsis in febrile neutropenia (FN) is a life threatening condition, and a health problem of increasing proportions. Although multiple organ dysfunction syndrome (MODS) frequently precedes death in patients with sepsis, the ultimate mechanisms responsible for organ dysfunction and tissue damage in sepsis are yet to be determined. Currently, tissue damage is attributed to an exacerbated response of the immune and hemostatic systems, mediated by endothelial cells, platelets and neutrophils. Of note, recent evidence demonstrated that neutrophils, platelets and fibrin participate in this response by mediating neutrophil extracellular traps (NET) formation, and promoting the hemostatic containment of infectious foci. In animal models, down-regulation of NET formation, coagulation and platelet activation are usually associated with deficiencies in pathogen clearance. Unfortunately, activation of hemostasis and NET formation could potentially contribute to tissue damage by a process called "immunethrombosis". Although the increase of sepsis severity in patients with severe neutropenia is well described, the mechanisms of sepsis-associated tissue damage in the context of severe neutropenia/thrombocytopenia are yet to be determined. Methods: In order to investigate the mechanisms of tissue damage in the context of severe neutropenia/thrombocytopenia, we compiled clinical data from two different prospective sepsis cohorts (A, neutropenic; n=129; and B, non-neutropenic; n=30) followed at our Institution. In addition, we reviewed histopathological data from 16 autopsies of individuals with hematological malignancies and septic shock from our institution (cohort C; n=16). H&E-stained slides from liver, kidneys and lungs were systematically analyzed by one investigator, and reviewed by 2 experienced pathologists, all of them blind to the presence or absence of neutropenia and thrombocytopenia. In each organ, we characterized (as present or absent) three main organic lesions: thrombi in microvessels, microorganism colonies, and inflammatory infiltrate (mononuclear and polymorphonuclear). Inflammation was graded as weak or intense, and only considered when there was no neoplastic infiltration. Results: Median ages of patients from cohorts A and B were respectively 46.0 years (13-78), and 59.4 years (22-85); P<0.0001. In cohort A, neutrophil counts were < 100/mcl in 55.8% of patients and between 100-500/mcl in 42.6%. Platelet counts were also lower in cohort A (30,126 vs 213,933/mcl; P<0.0001). Median SOFA scores (at admission) were 4 (0-15) and 5 (0-17); P=0.3 in neutropenic and non-neutropenic patients respectively, and sepsis-related mortality was 22.5% and 10.3% in the same groups (P=0.19). Among patients with a higher SOFA score, mortality was higher in neutropenic patients (100% vs 33.3%; p=0.04). The frequencies of clinically-evident infection foci were 60% in cohort A and 100% in cohort B (P=0.0001). In contrast, positive blood cultures were present in 38% of neutropenic, but in only 3.3% of non-neutropenic patients (P<0.0001). The autopsy-based study included 10 patients with lymphoma and 6 with acute leukemia. The cause of death was septic shock in all of them, and three patients presented severe neutropenia (<500/mcl). The main histological findings are shown in table 1. The only neutropenic patient with microthrombi presented AML-M3 and leukostasis. Using H&E staining, no bacterial colonies were found in any slide. Conclusions: as expected, septic patients with severe neutropenia presented a worse outcome compared to non-neutropenic patients in our cohort. In addition, the lower frequency of clinically-defined infectious foci, coupled with a strikingly higher frequency of positive blood cultures, suggest that severe neutropenia and thrombocytopenia could impair pathogen containment and clearance. Severe neutropenia/thrombocytopenia was compatible with inflammatory infiltrates and microvascular thrombosis in lungs, although the latter was only observed in a patient with leukostasis and promyelocityc acute leukemia. Table 1. Histological findings in autopsies of neutropenic and non-neutropenic patients Microthrombi Inflammation (weak/intense) Lungs Kidney Liver Lungs Kidney Liver Neutropenic 33% 33% 0% 50%/50% 0%/0% 0%/0% Non-neutropenic 56.25% 25% 6.25% 70%/20% 34%/9% 67%/0% Disclosures No relevant conflicts of interest to declare.

scholarly journals Granulocyte transfusions: current status

Blood ◽  
1980 ◽  
Vol 55 (1) ◽  
pp. 2-8
Author(s):  
DJ Higby ◽  
D Burnett
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Clinical Medicine ◽  
Bone Marrow Failure ◽  
Current Status ◽  
Granulocyte Transfusion ◽  
Transfusion Therapy ◽  
Neutropenic Patients ◽  
Ongoing Evaluation ◽  
Made In

Since granulocyte transfusions first became widely used in clinical medicine, there have been advances in the treatment of acute leukemia and improvement in prevention and management of infection in neutropenic patients. Improved understanding now exists concerning prognosis of infections in such patients, and advances have been made in procurement of granulocytes. Granulocyte transfusions should be given for specific indications, and used adjunctively to other established antiinfective therapy. Once initiated, transfusions should be given in adequate doses at daily intervals (at least) with ongoing evaluation and periodic reassessment of the whole antiinfective program. Serious complications of granulocyte transfusion therapy are relatively rare, but the physician should be prepared to manage them intelligently. Research continues in discerning exactly how granulocyte transfusion work, in preservation of granulocytes, and in delineation of immunologic phenomena affecting the efficiacy of such therapy. Granulocyte transfusions will continue to be important in the management of acute leukemia, and other reversible bone marrow failure states, and in marrow transplantation and autotransplantation.

Monitoring of 1,3-Beta-D-Glucan (BGL) Antigenemia in Neutropenic Patients with Acute Leukemia at High Risk for Invasive Fungal Infections (IFI).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2924-2924
Author(s):  
Laurence Senn ◽  
James O. Robinson ◽  
Sabine Schmidt ◽  
Marlies Knaup ◽  
Nobuo Asahi ◽  
...  
Keyword(s):  
High Risk ◽  
Early Diagnosis ◽  
Acute Leukemia ◽  
Likelihood Ratio ◽  
Median Time ◽  
Antifungal Therapy ◽  
Diagnostic Performance ◽  
Fever Onset ◽  
Neutropenic Patients ◽  
Febrile Episodes

Abstract Invasive candidiasis (IC) and aspergillosis (IA), the most frequent IFI in leukemic patients, are associated with high morbidity and mortality. As early diagnosis of IFI is difficult, empirical antifungal therapy is recommended in persistently febrile neutropenic patients. This standard of care results in a broad use of antifungals. New non-invasive diagnostic tests such as circulating BGL, a fungal cell wall component, are thus needed to optimize management of patients with IFI. The objective of the current study was to evaluate the utility of monitoring BGL antigenemia in neutropenic patients at high risk for IFI. We conducted a prospective study of 189 episodes of neutropenia (median duration 22 days, range 7–113) following induction (n=107) or consolidation chemotherapy (n=82) in 99 consecutive patients with acute leukemia (85 AML, 14 ALL). Blood was collected 2× weekly before onset of fever and daily thereafter until resolution of fever. BGL was measured by colorimetric assay (Wako, Japan). Two cut-off values (5 or 11 pg/ml) were studied. A positive result was defined by 2 consecutive samples with BGL higher than the cut-off value. A median of 2 (0–4) febrile episodes occurred per neutropenic episode. Among 320 febrile episodes, 31 IFI were diagnosed according to EORTC-MSG criteria: 17 IC (4 proven, 13 probable) and 14 IA (5 proven, 9 probable). A median of 15 samples (4–47) per episode of neutropenia were analyzed over a median period of 34 days (19–121). The diagnostic performance of BGL was evaluated in patients with proven or probable IFI compared with febrile patients without IFI (Table). In patients with IC, the median time between onset of fever as first sign of IFI and BGL positivity (>= 5) was 0 (−3 to 17 days) as compared with 16 (0 to 51 days) until diagnosis of infection using conventional microbiological and imaging techniques (p=0.03). In IA patients, it was 3 (−9 to 14 days) vs. 7 (1 to 21 days) (p=0.07). In IC and IA, median peak BGL (21 [6–111] and 15 [7–51] pg/ml) occurred on day 13 (1 to 41) and on day 7 (3 to 20) after fever onset, respectively. Median time to initiation of antifungal therapy after fever onset was similar in IC (2.5, range: 1 to 10 days) and IA (5, range: 0 to 10 days). BGL antigenemia decreased or cleared in patients responding to therapy (n=19) and continued to increase (peak 111 and 66 pg/ml) in 2 cases of IC, in whom therapy failed. BGL was negative (< 5 pg/ml) in 100/102 episodes of bacteremia. In conclusion, monitoring of 1,3-beta-D-glucan antigenemia provides a new tool for early diagnosis and follow-up of IFI in neutropenic patients with acute leukemia. Diagnostic Performance of BGL BGL Cut-off (pg/ml) 2 × 5 2 × 5 2 × 5 2 × 11 2 × 11 2 × 11 Type of proven/probable IFI IC IA All IFI IC IA All IFI Sensitivity % 65 93 76 35 43 38 Specificity % 89 89 89 99 99 99 PPV % 48 52 65 86 86 92 NPV % 94 99 93 91 93 86 Positive Likelihood Ratio 5.9 8.5 6.9 35 43 38 Negative Likelihood Ratio 0.4 0.1 0.3 0.7 0.6 0.6

scholarly journals 1,3- -D-Glucan Antigenemia for Early Diagnosis of Invasive Fungal Infections in Neutropenic Patients with Acute Leukemia

2008 ◽  
Vol 46 (6) ◽  
pp. 878-885 ◽  
Author(s):  
L. Senn ◽  
J. O. Robinson ◽  
S. Schmidt ◽  
M. Knaup ◽  
N. Asahi ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Acute Leukemia ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Neutropenic Patients

scholarly journals 2675. Changing Epidemiology of Bloodstream Infection During Chemotherapy for Acute Leukemia: Impact of Prophylactic Fluoroquinolone Restriction and Carbapenem Saving Strategy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S938-S939
Author(s):  
Yunmi Yi ◽  
Sung-Yeon Cho ◽  
Dong-Gun Lee ◽  
Jae-Ki Choi ◽  
Hyo-Jin Lee ◽  
...  
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Acute Leukemia ◽  
Bloodstream Infection ◽  
Remission Induction ◽  
Period 2 ◽  
Defined Daily Doses ◽  
Neutropenic Patients ◽  
The Impact ◽  
Fluoroquinolone Prophylaxis

Abstract Background Fluoroquinolone prophylaxis has been widely used in high-risk neutropenic patients with hematological malignancies, which may reduce bloodstream infection (BSI) and mortality. However, concerns about antibiotic resistance also exist. The aim of this study was to assess the impact of new institutional strategy of restricting fluoroquinolone prophylaxis and saving carbapenem, applied since October 2016. Fluoroquinolone prophylaxis was adopted only in remission induction chemotherapy, and carbapenems were saved until other antibiotics prove no effectiveness Methods We retrospectively reviewed all consecutive intensive chemotherapy episodes for acute leukemia from April 2016 to March 2017 at the Catholic Hematology Hospital. In addition, antibiotics consumption was assessed by calculating defined daily doses (DDDs) per 100 bed-days. Results Among 420 admissions during the study period, 201 and 219 admissions were identified before (period 1) and after (period 2) the strategy modification. Baseline characteristics including types of leukemia, chemotherapy, severity and duration of neutropenia were not different between the two periods.Development of febrile neutropenia (83.6% vs. 84.0%, P = 0.487), BSI (46.3% vs. 52.5%, P = 0.291), and septic shock (4.0% vs. 6.4%, P = 0.268) were not significantly different. Polymicrobial BSI increased significantly (7.1% vs. 20.0%, p = 0.012) in period 2. Quinolone resistance (97.8% vs. 43.6%, P < 0.001) and extended-spectrum β-lactamase producers (50% vs. 29.1%, P = 0.032) among Enterobacteriaceae were significantly reduced. Carbapenem-resistant Enterobacteriaceae was not isolated in period 2. Vancomycin resistance among enterococci (66.7% vs. 15%, P = 0.006) decreased. Consumption of ciprofloxacin (37.2 vs. 13.8) and carbapenem (22.3 vs. 16.8) decreased, while piperacillin/tazobactam consumption increased (5.2 vs. 13.0). BSI-related death (1.0% vs. 0.9%) was not increased. Conclusion Fluoroquinolone prophylaxis restriction and carbapenem saving strategies resulted in significant reduction of resistant bacterial BSIs, without increase in febrile neutropenia, BSI, septic shock, and BSI-related death. Antibiotics stewardship program can be tried in neutropenic patients, which may improve the ultimate outcome. Disclosures All authors: No reported disclosures.

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