Shun-Ichi Kimura1, Hiroyuki Fujita2, Hideaki Kato3, Nobuhiro Hiramoto4, Naoko Hosono5, Tsutomu Takahashi6, Kazuyuki Shigeno7, Naoko Hatsumi8, Hitoshi Minamiguchi9, Junichi Miyatake10, Hiroshi Handa11, Nobu Akiyama12, Yoshinobu Kanda1,13, Minoru Yoshida14, Hitoshi Kiyoi15, Yasushi Miyazaki16, Tomoki Naoe17. 1. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan. 2. Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan. fujitah@nanbu.saiseikai.or.jp. 3. Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 4. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan. 5. Department of Hematology and Oncology, University of Fukui, Fukui, Japan. 6. Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan. 7. Department of Hematology, Hamamatsu Medical Center, Hamamatsu, Japan. 8. Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan. 9. Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, Japan. 10. Department of Hematology, Sakai Hospital Kinki University Faculty of Medicine, Sakai, Japan. 11. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan. 12. Department of Hematology/Oncology, Teikyo University School of Medicine, Tokyo, Japan. 13. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan. 14. Fourth Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi hospital, Kawasaki, Japan. 15. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 16. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 17. National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
Abstract
PURPOSE: We performed a nationwide questionnaire-based survey to evaluate the current clinical practices of infectious complications during chemotherapy for acute leukemia in Japan. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: We performed a nationwide questionnaire-based survey to evaluate the current clinical practices of infectious complications during chemotherapy for acute leukemia in Japan. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
Acute leukemia; Antimicrobial prophylaxis; Empirical therapy; Febrile neutropenia; Infectious complication; Japan Adult Leukemia Study Group
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