Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

Gafter‐Gvili, Anat; Fraser, Abigail; Paul, Mical; Vidal, Liat; Lawrie, Theresa A; Wetering, Marianne D. van de; Kremer, Leontien C. M.; Leibovici, Leonard

doi:10.1002/14651858.cd004386.pub3

Cited by 210 publications

(184 citation statements)

References 168 publications

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“…First, concomitant antibiotic prophylaxis was associated with increased risk of negative outcome—when, clinically, one might expect an attenuating effect: 12.2% of patients were prescribed antibiotic prophylaxis at enrollment and concomitant antibiotic prophylaxis was recorded in 9.8% of cycles. These rates may be due to the lower proportion of patients with hematological malignancies in our study—when such patients especially benefit from prophylaxis [20]. It may also reflect the limited evidence base on antibiotic prophylaxis in the hematological setting; the fact that the EORTC guidelines focus on solid tumors and do not detail indications for prophylaxis in the hematological setting; and that the use of antibiotics in this setting is often protocol-driven.…”

Section: Discussionmentioning

confidence: 96%

Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study)

et al. 2016

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Section: Discussionmentioning

confidence: 96%

Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study)

et al. 2016

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“…Close inpatient monitoring was felt to be necessary because of the frequent transfusion requirements and the risk for serious infectious complications, a major contributor to early death (“treatment-related mortality” [TRM]) after intensive AML therapy [1,2]. Over the past 2 decades, however, TRM rates of AML patients following induction chemotherapy have significantly declined [3,4], a trend that is primarily attributable to improvements in supportive care, including the administration of prophylactic antimicrobials during neutropenia [5] and the availability of more efficacious broad-spectrum antimicrobials for the treatment of neutropenic fever/infection [6,7]. As clinicians and medical support staff have become more comfortable preventing, recognizing, and treating the complications associated with aggressive AML treatment, an interest in moving patient care partially to the outpatient setting has emerged.…”

Section: Introductionmentioning

confidence: 99%

Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations

2016

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Patients with acute myeloid leukemia (AML) who receive intensive induction or re-induction chemotherapy with curative intent typically experience prolonged cytopenias upon completion of treatment. Due to concerns regarding infection and bleeding risk as well as significant transfusion and supportive care requirements, patients have historically remained in the hospital until blood count recovery—a period of approximately 30 days. The rising cost of AML care has prompted physicians to reconsider this practice, and a number of small studies have suggested the safety and feasibility of providing outpatient supportive care to patients following intensive AML (re-) induction therapy. Potential benefits include a significant reduction of healthcare costs, improvement in quality of life, and decreased risk of hospital-acquired infections. In this article, we will review the currently available literature regarding this practice and discuss questions to be addressed in future studies. In addition, we will consider some of the barriers that must be overcome by institutions interested in implementing an “early discharge” policy. While outpatient management of selected AML patients appears safe, careful planning is required in order to provide the necessary support, education and rapid management of serious complications that occur among this very vulnerable patient population.

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“…Bacterial infections are a major cause of morbidity and mortality in patients receiving chemotherapy for malignancy [44], [45]. In chemotherapy for MDR cancer, inhibition of ABCG2 is expected to enhance the efficacy of the anti-cancer drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of Breast Cancer Resistance Protein (ABCG2) in Human Myeloid Dendritic Cells Induces Potent Tolerogenic Functions during LPS Stimulation

et al. 2014

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Breast cancer resistance protein (ABCG2), a member of the ATP-binding cassette transporters has been identified as a major determinant of multidrug resistance (MDR) in cancer cells, but ABC transporter inhibition has limited therapeutic value in vivo. In this research, we demonstrated that inhibition of efflux transporters ABCG2 induced the generation of tolerogenic DCs from human peripheral blood myeloid DCs (mDCs). ABCG2 expression was present in mDCs and was further increased by LPS stimulation. Treatment of CD1c+ mDCs with an ABCG2 inhibitor, Ko143, during LPS stimulation caused increased production of IL-10 and decreased production of pro-inflammatory cytokines and decreased expression of CD83 and CD86. Moreover, inhibition of ABCG2 in monocyte-derived DCs (MDDCs) abrogated the up-regulation of co-stimulatory molecules and production of pro-inflammatory cytokines in these cells in response to LPS. Furthermore, CD1c+ mDCs stimulated with LPS plus Ko143 inhibited the proliferation of allogeneic and superantigen-specific syngenic CD4+ T cells and promoted expansion of CD25+FOXP3+ regulatory T (Treg) cells in an IL-10-dependent fashion. These tolerogenic effects of ABCG2 inhibition could be abolished by ERK inhibition. Thus, we demonstrated that inhibition of ABCG2 in LPS-stimulated mDCs can potently induce tolerogenic potentials in these cells, providing crucial new information that could lead to development of better strategies to combat MDR cancer.

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Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

Cited by 210 publications

References 168 publications

Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study)

Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study)

Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations

Inhibition of Breast Cancer Resistance Protein (ABCG2) in Human Myeloid Dendritic Cells Induces Potent Tolerogenic Functions during LPS Stimulation

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