Management of infection in patients with acute leukemia during chemotherapy in Japan: questionnaire analysis by the Japan Adult Leukemia Study Group

Abstract

Guidelines for the management of febrile neutropenia (FN), deep fungal infection or use of granulocyte colony-stimulating factor (G-CSF) published in the US and Europe cannot be directly applied in other countries. In this study, we undertook a questionnaire survey of member institutions of the Japan Adult Leukemia Study Group to investigate the status of, and problems with, the management of infectious complications in patients with acute leukemia. The questionnaire consisted of 52 multiple-choice questions covering therapeutic environment, antibacterial, and antifungal prophylaxis, empirical therapy (ET) for FN, and use of G-CSF. The results were compared to a previous survey performed in 2001. Usable responses were received from 134 of 184 (71.7%) institutions. With regard to antibacterial prophylaxis, fluoroquinolones and sulfamethoxazole-trimethoprim were most commonly used. Regarding antifungal prophylaxis, the most frequently used agent was fluconazole, followed by itraconazole. In ET for FN, monotherapy with cephems or carbapenems accounted for almost all of the responses. Most respondents indicated that they used micafungin (MCFG) in ET. Prophylactic use of G-CSF during remission induction therapy in acute myeloid leukemia was reported by only 4% of respondents. Strategies for antibacterial and antifungal prophylaxis or treatment of FN should be reviewed and updated as needed.

Appendix 1: Institutions responding to the questionnaire

Nihon University School of Medicine, Higashijujo Hospital, Kasukabe Municipal Hospital, Tokyo Metropolitan Komagome Hospital, Nagoya University Graduate School of Medicine, Daido Hospital, Yokkaichi Municipal Hospital, Aichi Cancer Center, Japanese Red Cross Nagoya First Hospital, Fujita Health University School of Medicine, Mie University Graduate School of Medicine, Suzuka Kaisei Hospital, Takeuchi Hospital, Kinki University School of Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Shikoku Cancer Center, Atomic Bomb Disease Institute - Nagasaki University, Graduate School of Biomedical Sciences, Sasebo City General Hospital, National Hospital Organization Nagasaki Medical Center, Kumamoto University School of Medicine, Kumamoto City Hospital, NTT West Kyushu General Hospital, Jichi Medical School, Okayama University Hospital, National Hospital Organization Minami-Okayama Medical Center, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers, National Hospital Organization Okayama Medical Center, Okayama Rosai Hospital, Kagawa Rosai Hospital, Gunma University Graduate School of Medicine, National Hospital Organization Nishigunma National Hospital, Fukaya Red Cross Hospital, University of Fukui, Kurashiki Central Hospital, Kanazawa Medical Center, Shimada Municipal Hospital, National Cancer Center Hospital, International Medical Center, Saitama Medical University, Hyogo College of Medicine, National Hospital Organization Osaka National Hospital Internal Medicine, Takarazuka Municipal Hospital, Uegahara Hospital, Kawasaki Medical School, Chiba University Hospital, Chiba Aoba Municipal Hospital, Social Insurance Funabashi Central Hospital, Nara Medical University, Jikei University School of Medicine, Dokkyo University School of Medicine, National Hospital Organization Nagoya Medical Center, Kochi Medical School - Kochi University, Shiga University of Medical Science, National Cancer Center East, Anjo Kosei Hospital, St. Marianna University School of Medicine, Yokohama Seibu Hospital, Shinshu University School of Medicine, Nagano Red Cross Hospital, Tokyo Women’s Medical University, Tama-Hokubu Medical Center, Hamamatsu University School of Medicine, Fujieda Municipal General Hospital, Kagoshima University Hospital, Tochigi Cancer Center, Kanazawa University Graduate School of Medical Science, Toyama City Hospital, Seirei Numazu Hospital, Hematology, Tokyo Medical, University, Kyorin University School of Medicine, Hokkaido University Graduate School of Medicine, Sapporo Kousei Hospital, Hakodate Central Hospital, Saiseikai Maebashi Hospital, Higashi Municipal Hospital of Nagoya, Tokai University School of Medicine, Yamaguchi University School of Medicine, Yamaguchi Prefecture Central Hospital, Osaka City University, University of Tokyo, Niigata University, Medical and Dental Hospital, Oita University Faculty of Medicine, Oita Prefectural Hospital, Kouseiren Tsurumi Hospital, National Kyushu Cancer Center, National Hospital Organization Kyushu Medical Center, Fukuoka Postal Services Agency Hospital, Aso Iizuka Hospital, Teikyo University School of Medicine, Teikyo University Mizonokuchi Hospital, Sapporo Hokuyu Hospital, Aichi Medical University, Yamagata University Faculty of Medicine, Aomori Prefectural Central Hospital, Hyogo Cancer Center, Kyoto Prefectural University of Medicine, Social Insurance Kyoto Hospital, Social Insurance Kobe Central Hospital, National Hospital Organization Shiga Hospital, National Defense Medical College, Akita University School of Medicine, NTT Kanto Medical Center, Yokohama City University Hospital, Yokohama City University Medical Center, Kanagawa Cancer Center, Fujisawa City Hospital, Shizuoka Red Cross Hospital, Tohoku University School of Medicine, Osaki Citizen Hospital, Hiroshima University, Kagawa University, Kagawa Prefectural Central Hospital, Sakaide City Hospital, Juntendo University School of Medicine, Kanazawa Medical University, Kobe University Graduate School of Medicine, Jiaikai Imamura Bun-in Hospital, Ehime University Graduate School of Medicine, Metropolitan Bokuto Hospital, Otsu Red Cross Hospital, Yokohama City Minato Red Cross Hospital, Saitama Medical Center Jichi Medical University, Ehime Prefectural Central Hospital, International Medical Center of Japan, National Hospital Organization Kure Medical Center, Nagoya Daini Red Cross Hospital, University of Yamanashi Hospital, Heartlife Hospital, Musashino Red Cross Hospital, Saitama Medical Center, PL Hospital, Toyama Prefectural Central Hospital, Shimane Prefectural Central Hospital, Miyagi Cancer Center.