International Journal of Hematology

, Volume 90, Issue 2, pp 191–198 | Cite as

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

  • Hiroyuki Fujita
  • Minoru Yoshida
  • Katsuhiro Miura
  • Tetsuaki Sano
  • Katsuyuki Kito
  • Masatomo Takahashi
  • Kazuyuki Shigeno
  • Yoshinobu Kanda
  • Nobu Akiyama
  • Naoko Hatsumi
  • Kazunori Ohnishi
  • Shuichi Miyawaki
  • Tomoki Naoe
Original Article

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.

Keywords

JALSG Febrile neutropenia Prophylaxis G-CSF Leukemia 

Notes

Acknowledgments

This work was supported in part by a grant from Japan Adult Leukemia Study Group.

References

  1. 1.
    Masaoka T. Evidence-based recommendations on antimicrobial use in febrile neutropenia in Japan. Int J Hematol. 1998;68(Suppl 1):1–40.Google Scholar
  2. 2.
    Masaoka T. Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary. Clin Infect Dis. 2004;39(Suppl 1):S49–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Yoshida M, Akiyama N, Takahashi M, Taguchi H, Takeuchi J, Naito K, et al. Management of infectious complications in patients with acute leukemia during chemotherapy: a questionnaire analysis by the Japan Adult Leukemia Study Group. Jpn J Chemother. 2003;51:703–10.Google Scholar
  4. 4.
    Yoshida M, Ohno R. Current antimicrobial usage for the management of infections in leukemic patients in Japan: results of a survey. Clin Infect Dis. 2004;39(Suppl 1):S11–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med. 2005;142:979–95.PubMedGoogle Scholar
  7. 7.
    Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G, et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med. 2005;353:977–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Robenshtok E, Gafter-Gvili A, Weinberger M, Yeshurun M, Leibovici L, Paul M. Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. J Clin Oncol. 2007;25:5471–89.PubMedCrossRefGoogle Scholar
  9. 9.
    Pizzo PA, Hathorn JW, Hiemenz J, Browne M, Commers J, Cotton D, et al. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med. 1986;315:552–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Tamura K, Imajo K, Akiyama N, Suzuki K, Urabe A, Ohyashiki K, et al. Randomized trial of cefepime monotherapy or cefepime in combination with amikacin as empirical therapy for febrile neutropenia. Clin Infect Dis. 2004;39(Suppl 1):S15–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347:408–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith TJ, Khatcheressian J, Lyman GH, Ozer H, Armitage JO, Balducci L, et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006;24(19):3187–205.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2009

Authors and Affiliations

  • Hiroyuki Fujita
    • 1
    • 2
  • Minoru Yoshida
    • 2
  • Katsuhiro Miura
    • 2
  • Tetsuaki Sano
    • 2
  • Katsuyuki Kito
    • 2
  • Masatomo Takahashi
    • 2
  • Kazuyuki Shigeno
    • 2
  • Yoshinobu Kanda
    • 2
  • Nobu Akiyama
    • 2
  • Naoko Hatsumi
    • 2
  • Kazunori Ohnishi
    • 2
  • Shuichi Miyawaki
    • 2
  • Tomoki Naoe
    • 2
  1. 1.Department of Rheumatology/Hematology/Infectious DiseaseYokohama City University HospitalYokohamaJapan
  2. 2.Japan Adult Leukemia Study GroupHamamatsuJapan

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