Cancer febrile neutropenia

It is clear that patients with febrile neutropenia represent a heterogeneous group. Some patients are at lower risk and potentially could be treated as outpatients, thereby avoiding the risk and cost of hospitalization. The Multinational Association for Supportive Care in Cancer (MASCC) has validated a risk-assessment tool that assigns a risk score to patients presenting with febrile neutropenia7 (Table 96-3). Patients with a risk-index score of 21 or greater are identified as low risk and are candidates for outpatient therapy (discussed under Treatment ). 

Neulasta, Pegfilgrastim, G-CSF-PEG Amgen, Inc. Infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelo-suppressive anti-cancer drugs Jan. 2002... 

An acute reversible arthropathy has been described in a child with cancer treated with a short course of ciprofloxacin for febrile neutropenia (58). 

However, home care can also give support to the patient with cancer in other areas parenteral antibiotics in febrile neutropenia, nutrition and fluid support, or pain support. 

Given the potential mortality and known morbidity associated with febrile neutropenia, it may seem surprising that the routine use of TPMT genotyping in defining dose regimens for children with cancer did not gain early wide spread acceptance in the broader community of pediatric oncologists [15], There are several... 

A key controversy in the management of febrile neutropenia in cancer patients is the optimal time to stop empirical antimicrobial therapy in patients who remain persistently febrile. Patients individual risk of severe infection (determined by extent and duration of neutropenia, as well as other risk factors) helps to guide treatment decisions in this setting. 

Feld R. Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer Pros and cons. Qin Infect Dis 1999 29 503-507. 

Myelosuppression, which creates risk of infection and bleeding, is the acute dose-limiting toxicity for most nonspecific cancer drugs. The risk of infection in neutropenic patients is related to the depth and duration of neutropenia. The only reliable indicator of infection in neutropenic patients is fever. Unexplained fever in neutropenic patients requires prompt initiation of empiric antibiotic therapy. Colony-stimulating factors may reduce the risk of febrile neutropenia. Evidence-based clinical guidelines should di-rect the use of costly supportive care resources such as hematopoietic growth factors. 

Administration of the probiotic E. faecium strain probably leads to the competition with and elimination of pathogenic bacteria from the intraepithelial niche. Therefore it can be considered that application of non-pathogenic E. faecium can be a promising method for elimination of pathogenic bacteria in the case of inflammatory bowel disease and colon cancer. The same strain of E. faecium was nsed also for the prevention of febrile neutropenia in lenkemic patients. Tolerance of therapy was excellent without significant adverse effects. However, the administration of the enterococcal strain was not effected in the prevention of febrile neutropenia bnt no febrile episode or infection provoked by the probiotic strain E. faecium was noticed (Mego et al. 2005a, 2006). 

In a study, 627 patients with breast cancer were given either doxorubicin 50 mg/m with docetaxel 75 mg/m, or doxorubicin 60 mg/m with cyclophosphamide 600 mg/m postoperatively for 4 courses to assess disease-free survival at 5 years. The study was terminated prematurely because of the high risk of life-threatening complications in those given doxorubicin with docetaxel (2 deaths associated with drug toxicity and one case of perforated peritonitis in patients with febrile neutropenia). The incidence of febrile neutropenia was 40.8% and 7.1% in the doxorubicin-docetaxel and doxorubicin-cyclophosphamide groups, respectively. ... 

In Phase I trials in the UK, HPMA copolymer doxombicin (PKl) given once every three weeks, had significantly reduced toxicity when compared to free doxombicin. The maximum tolerated dose, toxicity profile, and pharmacokinetics of PKl as an i.v. infusion every 3 weeks to patients with refractory or resistant cancers was determined. In the most recent report, 100 cycles were administered (range, 20-320 mg/m [free dmg equivalent]) to 36 patients (20 males and 16 females) with a mean age of 58.3 years (age range, 34-72 years). The maximum tolerated dose was 320 mg/m, and the dose-limiting toxicities were febrile neutropenia and mucositis. This maximum tolerated dose was a 4-5 fold increase over the usual clinical doses (60-80 mg/m ). No congestive cardiac failure was seen despite individual cumulative doses up to 1680 mg/m. Other anthracycline-like toxicities were attenuated. Pharmacokinefically, PKl had a distribution t(l/2) of 1.8 h and... 

Adverse events risks associated with the addition of bevacizumab to breast cancer chemotherapy were recently assessed in a review and meta-analysis that included five phase III clinical trials that used bevacizumab alone or in combination with chemotherapy [96 ]. Four adverse events, proteinuria, hypertension, l t ventricular dysfunction and haemorrhagic events, showed a statistically significant bevacisumab-associated risk while no significant risk was found for gastrointestinal perforation, vascular events, febrile neutropenia and fatal events. 

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