Re: “Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis” by Horita et al.

Averbuch, Dina; Orasch, Christina; Mikulska, Małgorzata; Livermore, David M.; Viscoli, Claudio; Gyssens, Inge C.; Kern, Winfried V.; Klyasova, Galina; Marchetti, Oscar; Engelhard, Dan; Akova, Murat; Calandra, Thierry; Cordonnier, C

doi:10.1016/j.cmi.2018.01.012

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…Although there are data to support DE in patients who are afebrile for at least 48 hours, the team felt more comfortable using a 72 hour timeframe to distinguish any new fevers arising from new infections being related to DE. 5 The primary endpoint was the difference in number of antibiotic therapy days between the pre and post DE group. 'Antibiotic therapy days' was defined as the total number of days that empiric broad spectrum antipseudomonal antibiotics were administered upon presentation of initial fever, excluding any prophylactic antimicrobials.…”

Section: Methodsmentioning

confidence: 99%

“…4 Early antibiotic DE is endorsed by the European Conference on Infections in Leukemia guidelines, which recommend discontinuing antibiotics after 72 hours if a neutropenic patient has been stable since presentation and has been afebrile for at least 48 hours. 5 While there is emerging guidance to support antibiotic DE before neutropenic recovery, there is no universal consensus to implement this practice, and the supporting evidence is based on limited data, especially in a highly immunocompromised HCT and chimeric antigen (CAR) Tcell therapy patient population.…”

Section: Introductionmentioning

confidence: 99%

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Early de-escalation of antibiotic therapy in hospitalized cellular therapy adult patients with febrile neutropenia

Lucena,

Gaffney,

Urban

et al. 2024

Clinical Hematology International

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Febrile neutropenia (FN) is an oncologic emergency frequently encountered in hematopoietic cell transplant (HCT) and chimeric antigen receptor (CAR) T-cell therapy patients, which requires immediate initiation of broad-spectrum antibiotics. Data regarding antibiotic de-escalation (DE) in neutropenic patients are limited, and guideline recommendations vary. A clinical protocol for antibiotic DE of broad-spectrum agents was implemented if patients were afebrile after 72 hours and had no clinical evidence of infection. The primary endpoint was the difference in the number of antibiotic therapy days between the pre-and post-DE protocol implementation group. Secondary endpoints included rates of subsequent bacteremia during index hospitalization, 30-day mortality, and hospital length of stay. Retrospective chart reviews were conducted to assess outcomes for patients who received allogeneic HCT, autologous HCT, or CAR T-cell therapy under the antibiotic de-escalation protocol (post-DE) compared to those who did not (pre-DE). The pre-DE group underwent HCT/CAR T-cell from February 2018 through September 2018 (n=64), and the post-DE group from February 2019 through September 2019 (n=67). The median duration of antibiotics was significantly lower in the post-DE group (6 days; range 3-60 days) compared to the pre-DE group (8 days; range 3-31 days) (p=0.034). There were no differences in any secondary endpoints. We conclude that antibiotic DE in neutropenic HCT or CAR T-cell therapy patients treated with broad-spectrum antibiotics for at least three days who are afebrile and without documented infection appears to be a safe and effective practice. Adopting it significantly reduces the number of days of antibiotics without compromising patient outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early de-escalation of antibiotic therapy in hospitalized cellular therapy adult patients with febrile neutropenia

Lucena,

Gaffney,

Urban

et al. 2024

Clinical Hematology International

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“…Measures for managing febrile neutropenia were based on the guidelines of the Infectious Diseases Society of America and the European Conference on Infections in Leukemia. 26,27 Treatment-related toxicity and other adverse events were evaluated after each treatment course and were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.…”

Section: Genomic Analysis and Clearance Of Clonal Mutated Variantsmentioning

confidence: 99%

Minimally myelosuppressive regimen for remission induction in pediatric AML: long-term results of an observational study

Chen

Gao

et al. 2021

Blood Advances

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Treatment refusal and death as a result of toxicity account for most treatment failures among children with acute myeloid leukemia (AML) in resource-constrained settings. We recently reported the results of treating children with AML with a combination of low-dose cytarabine and mitoxantrone or omacetaxine mepesuccinate with concurrent granulocyte colony-stimulating factor (G-CSF) (low-dose chemotherapy [LDC]) for remission induction followed by standard postremission strategies. We have now expanded the initial cohort and have provided long-term follow-up. Eighty-three patients with AML were treated with the LDC regimen. During the study period, another 100 children with AML received a standard-dose chemotherapy (SDC) regimen. Complete remission was attained in 88.8% and 86.4% of patients after induction in the LDC and SDC groups, respectively (P = .436). Twenty-two patients in the LDC group received SDC for the second induction course. Significantly more high-risk AML patients were treated with the SDC regimen (P = .035). There were no significant differences between the LDC and SDC groups in 5-year event-free survival (61.4% ± 8.7% vs 65.2% ± 7.4%, respectively; P = .462), overall survival (72.7% ± 6.9% vs 72.5% ± 6.2%, respectively; P = .933), and incidence of relapse (20.5% ± 4.5% vs 17.6% ± 3.9%, respectively; P = .484). Clearance of mutations based on the average variant allele frequency at complete remission in the LDC and SDC groups was 1.9% vs 0.6% (P < .001) after induction I and 0.17% vs 0.078% (P = .052) after induction II. In conclusion, our study corroborated the high remission rate reported for children with AML who received at least 1 course of LDC. The results, although preliminary, also suggest that long-term survival of these children is comparable to that of children who receive SDC regimens.

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“…It seems that Dr. Averbuch considered that our systematic review recommends only imipenem/cilastatin in FN patients because imipenem/cilastatin was related to the highest treatment success rate and the lowest all-cause death rates [1]. However, we do not recommend imipenem/cilastatin solely: in the article, we clearly stated that imipenem/cilastatin, piperacillin/tazobactam, and meropenem may be reasonable first-choice medications for febrile neutropenia empiric therapy [2].…”

mentioning

confidence: 90%

Comparison of antipseudomonal β-lactams for febrile neutropenia empiric therapy: systematic review and network meta-analysis: authors' reply

Horita

Shibata

Watanabe

et al. 2018

Clinical Microbiology and Infection

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Re: “Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis” by Horita et al.

Cited by 6 publications

References 5 publications

Early de-escalation of antibiotic therapy in hospitalized cellular therapy adult patients with febrile neutropenia

Early de-escalation of antibiotic therapy in hospitalized cellular therapy adult patients with febrile neutropenia

Minimally myelosuppressive regimen for remission induction in pediatric AML: long-term results of an observational study

Comparison of antipseudomonal β-lactams for febrile neutropenia empiric therapy: systematic review and network meta-analysis: authors' reply

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