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General Management of Blood Cancers
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
The severity of neutropenia depends on and is defined by the ANC level. Severe neutropenia is defined as ANC of less than 0.5 x 109/L. Though there is no firm agreement of what constitutes febrile neutropenia, most specialists define this as a temperature > 38°C in the presence of an ANC of <0.5 × 109/L. The severity and duration of neutropenia is directly related to the risk of infection, which can progress rapidly. Fever is usually the predominant sign of infection and so febrile neutropenia often demands prompt hospitalization and administration of intravenous antibiotics.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
early hospital discharge, home intravenous antibiotic therapy, and oral antibiotic regimens. Due to rapid changes in the field, the reader is directed to specialized sources for specific management recommendations of febrile neutropenia.
Malignant Neoplasms of the Colon
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
The complication side of chemotherapy was poignantly highlighted in the report by Culakova et al. (468) who reviewed the hospitalization of colorectal carcinoma patients with febrile neutropenia at 115 academic medical centers. Over a 6-year period, 957 patients with colorectal carcinoma experienced 1046 hospitalizations with febrile neutropenia. The mean (median) length of stay was 9.0 days while the average (median) cost per hospitalization was $12,484 ($7153). The 30% of patients hospitalized ≥10 days accounted for 62% of all hospital days and 66% of all costs. Clinical infection was reported in 57% of patients, with microbiological documented infection reported in 31% including gram-negative sepsis in 8.5%, gram-positive in 2.7%, and other bacterial infections in 17.5%. Pneumonia was reported in 5% while 5% presented with hypotension and 34% with evidence of hypovolemia. Death occurred in 8.5% of hospitalizations. Mortality rates were greatest in those with gram-negative sepsis (35%), gram-positive sepsis (23%), hypotension (23%), and pneumonia (32%). One or more major comorbidities were reported in 57% of patients. Mortality rates increased with the number of comorbidities. Significant independent risk factors for mortality in multivariate analysis were gram-negative sepsis (OR = 6.1), gram-positive sepsis (OR = 3.8), hypovolemia (OR = 2.5), pneumonia (OR = 4.9), lung disease (OR = 4.6), liver disease (OR = 4.4), heart disease (OR = 3.9), and other vascular disease (OR = 13.3). One-third of hospitalized patients with febrile neutropenia experienced complicated hospitalizations with significant morbidity and mortality.
Impact of socio-behavioral measures implemented during the SARS-CoV-2 pandemic on the outcomes of febrile neutropenia episodes in pediatric cancer patients: a single center quasi-experimental pre-post study
Published in Pediatric Hematology and Oncology, 2023
Charles Nathaniel Nessle, Tom Braun, Vineet Chopra, Sung Won Choi, Rajen Mody
Patients analyzed were admitted with a diagnosis of febrile neutropenia, defined as an absolute neutrophil count (ANC) less than 0.5 K/µL or 1 K/µL with anticipation to decrease, a fever of 38 °C for greater than 1-h or single fever greater than 38.3 °C.24,25 All FN episodes included in analysis received inpatient management; location of first fever is reported as outpatient or inpatient setting. Oral temperature measurements were preferred and obtained by the primary caregiver if at home or a healthcare provider during admission using a digital thermometer as documented in the electronic health record. Admissions were excluded from the data analysis if they did not meet FN definition or bone marrow transplant recipients to restrict the analytic group to the general oncology cohort. Patients were allowed to have multiple FN episodes provided an interval of greater than 7 days was observed between febrile events. There were 9 FN episodes (1.8%) that occurred inpatient during an admission of a previous FN episode.
Colony stimulating factors for prophylaxis of chemotherapy-induced neutropenia in children
Published in Expert Review of Clinical Pharmacology, 2022
The first-line treatment of febrile neutropenia is antibiotic therapy and the identification of infection. Pediatric patients have a narrower choice of antibacterial agents compared to adults due to limited data and safety concerns. For example, there are controversies around the use of fluoroquinolones in children. Based on animal studies conducted in the 1970s, there is a perception that fluoroquinolones have potential toxicity to developing cartilage [46]. Although the American Academy of Pediatrics released a statement in 2011 about how fluoroquinolones are reasonably safe in children, fluoroquinolones are not as frequently prescribed in children compared in adults. Another concern in regards to antibiotic use in children is drug resistance. Antibiotics are the most commonly prescribed medications to children across all age groups [47].]It is necessary to assess the risk versus benefit of using empiric antibiotic therapy versus G-CSFs in children for primary prophylaxis of febrile neutropenia.
Ladiratuzumab vedotin for metastatic triple negative cancer: preliminary results, key challenges, and clinical potential
Published in Expert Opinion on Investigational Drugs, 2022
Alessandro Rizzo, Antonio Cusmai, Silvana Acquafredda, Lucia Rinaldi, Gennaro Palmiotti
Following preclinical evidence supporting the activity of this ADC, ladiratuzumab vedotin has been assessed in the phase I, multi-part, dose-escalation SGNLVA-001 trial [9]. Eligible subjects included two patient populations: 1) patients with first- or second-line endocrine therapy refractory hormone receptor-positive/HER2-negative metastatic breast cancer; 2) patients with second-line refractory metastatic triple-negative breast cancer [9]. No LIV-1 expression requirement was necessary for the study. According to the preliminary results of this study, overall response rate (ORR) and disease control rate (DCR) were 32% and 64%, respectively, among patients with metastatic triple-negative breast cancer, with a median progression-free survival (PFS) of 11.3 weeks. The majority of treatment-related adverse events were grade 1 or 2, the most commonly of which included fatigue (59%), nausea (51%), peripheral neuropathy (44%), and alopecia (36%). Two patients experienced febrile neutropenia, and one treatment-related death was reported; treatment discontinuation due to adverse events was observed in seven subjects. The updated results of this trial have been recently presented by Tsai and colleagues [10]. In second-line refractory triple negative breast cancer patients, ladiratuzumab vedotin at a dose of 1.25 mg/kg showed an ORR of 28%, confirming the promising activity of this agent.