Management of infection during chemotherapy for acute leukemia in Japan: a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group
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We performed a nationwide questionnaire-based survey to evaluate the current clinical practices of infectious complications during chemotherapy for acute leukemia in Japan.
We e-mailed a questionnaire to member institutions of the Japan Adult Leukemia Study Group in September, 2013. The questionnaire consisted of 50 multiple-choice questions covering therapeutic environment, antimicrobial prophylaxis, screening test during neutropenia, empirical therapy for febrile neutropenia, and the use of granulocyte-colony stimulating factor. The results were compared to those of previous surveys conducted in 2001 and 2007, and also to the recommendations described in the guidelines.
Usable responses were received from 141 out of 222 (63.5%) institutions. Chemotherapy for acute myeloid leukemia was performed in protective environment in 90% of the institutions, which increased compared to previous survey (76%). Fluoroquinolones and fluconazole were the most commonly used antimicrobial agents for antibacterial and antifungal prophylaxis, followed by sulfamethoxazole-trimethoprim and itraconazole, respectively. In empirical therapy for febrile neutropenia, monotherapy with β-lactum antibiotics was the first-line therapy in most of the institutions. While empirical antifungal therapy was adopted for persistent fever in more than half of the institutions, preemptive/presumptive therapy was also used in approximately 40% of the institutions. Most of the clinicians were reluctant to use granulocyte-colony stimulating factor routinely in chemotherapy for acute myeloid leukemia.
This study clarified the current clinical practices of infectious complications during chemotherapy for acute leukemia and would provide important information for the development of a suitable guideline in Japan.
KeywordsJapan Adult Leukemia Study Group Acute leukemia Infectious complication Febrile neutropenia Antimicrobial prophylaxis Empirical therapy
This work is supported in part by a grant from Japan Adult Leukemia Study Group.
Compliance with ethical standards
Conflict of interest
Shun-ichi Kimura received honoraria from Pfizer, Astellas, Sumitomo Dainippon Pharma, and Nippon Kayaku. Hiroyuki Fujita received honoraria from Novartis and payment for manuscripts from Chugai Pharmaceutical. Tsutomu Takahashi received grants from Chugai Pharmaceutical, Kyowa Hakko Kirin, and Astellas, and honoraria from Chugai Pharmaceutical, Kyowa Hakko Kirin, Taiho Pharmaceutical, and Celgene Corporation. Hiroshi Handa received payment for consultancy from Takeda Pharmaceutical, grants, and honoraria from Kyowa Hakko Kirin, Chugai Pharmaceutical, Takeda Pharmaceutical, Novartis, Bristol-Myers Squibb, Ono Pharmaceutical, and Astellas. Nobu Akiyama received grants from Shionogi, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Astellas, and payment for manuscripts from Taiho Pharmaceutical. Yoshinobu Kanda received grants from Astellas, Chugai Pharmaceutical, Kyowa Hakko Kirin, Shionogi, Sumitomo Dainippon Pharma, Pfizer, and Taisho Toyama Pharmaceutical, and honoraria from Pfizer, MSD, Astellas, Sumitomo Dainippon Pharma, and Kyowa Hakko Kirin. Minoru Yoshida received honoraria from Astellas, Sumitomo Dainippon Pharma, and MSD. Hitoshi Kiyoi received research funding from Chugai Pharmaceutical, Bristol-Myers Squibb, Kyowa Hakko Kirin, Zenyaku Kogyo, FUJIFILM Corporation, Nippon Boehringer Ingelheim, Astellas, and Celgene Corporation, consulting fees from Astellas and Daiichi Sankyo, and honoraria from Bristol-Myers Squibb and Pfizer. Yasushi Miyazaki received grants from Chugai Pharmaceutical, Kyowa Hakko Kirin, Astellas, and Novartis, and honoraria from Chugai Pharmaceutical, Kyowa Hakko Kirin, Astellas, Sumitomo Dainippon Pharma, Celgene Corporation, and Novartis. Other authors: none to declare.
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