Supportive Care in Cancer

, Volume 25, Issue 11, pp 3515–3521 | Cite as

Management of infection during chemotherapy for acute leukemia in Japan: a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group

  • Shun-ichi Kimura
  • Hiroyuki FujitaEmail author
  • Hideaki Kato
  • Nobuhiro Hiramoto
  • Naoko Hosono
  • Tsutomu Takahashi
  • Kazuyuki Shigeno
  • Naoko Hatsumi
  • Hitoshi Minamiguchi
  • Junichi Miyatake
  • Hiroshi Handa
  • Nobu Akiyama
  • Yoshinobu Kanda
  • Minoru Yoshida
  • Hitoshi Kiyoi
  • Yasushi Miyazaki
  • Tomoki Naoe
  • Japan Adult Leukemia Study Group (JALSG)
Original Article



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.


Japan 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.

Supplementary material

520_2017_3775_MOESM1_ESM.doc (336 kb)
ESM 1 (DOC 335 kb)
520_2017_3775_MOESM2_ESM.docx (18 kb)
ESM 2 (DOCX 18 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Shun-ichi Kimura
    • 1
  • Hiroyuki Fujita
    • 2
    Email author
  • Hideaki Kato
    • 3
  • Nobuhiro Hiramoto
    • 4
  • Naoko Hosono
    • 5
  • Tsutomu Takahashi
    • 6
  • Kazuyuki Shigeno
    • 7
  • Naoko Hatsumi
    • 8
  • Hitoshi Minamiguchi
    • 9
  • Junichi Miyatake
    • 10
  • Hiroshi Handa
    • 11
  • Nobu Akiyama
    • 12
  • Yoshinobu Kanda
    • 1
    • 13
  • Minoru Yoshida
    • 14
  • Hitoshi Kiyoi
    • 15
  • Yasushi Miyazaki
    • 16
  • Tomoki Naoe
    • 17
  • Japan Adult Leukemia Study Group (JALSG)
  1. 1.Division of Hematology, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
  2. 2.Department of HematologySaiseikai Yokohama Nanbu HospitalYokohamaJapan
  3. 3.Department of Hematology and Clinical ImmunologyYokohama City University Graduate School of MedicineYokohamaJapan
  4. 4.Department of HematologyKobe City Medical Center General HospitalKobeJapan
  5. 5.Department of Hematology and OncologyUniversity of FukuiFukuiJapan
  6. 6.Department of Oncology/HematologyShimane University HospitalIzumoJapan
  7. 7.Department of HematologyHamamatsu Medical CenterHamamatsuJapan
  8. 8.Leukemia Research CenterSaiseikai Maebashi HospitalMaebashiJapan
  9. 9.Department of Gastroenterology and HematologyShiga University of Medical ScienceOtsuJapan
  10. 10.Department of HematologySakai Hospital Kinki University Faculty of MedicineSakaiJapan
  11. 11.Department of Medicine and Clinical ScienceGunma University Graduate School of MedicineMaebashiJapan
  12. 12.Department of Hematology/OncologyTeikyo University School of MedicineTokyoJapan
  13. 13.Division of Hematology, Department of MedicineJichi Medical UniversityShimotsukeJapan
  14. 14.Fourth Department of Internal MedicineTeikyo University School of Medicine, Mizonokuchi hospitalKawasakiJapan
  15. 15.Department of Hematology and OncologyNagoya University Graduate School of MedicineNagoyaJapan
  16. 16.Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease InstituteNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  17. 17.National Hospital Organization Nagoya Medical CenterNagoyaJapan

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