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The American Journal of Nursing May 2023Febrile neutropenia is a serious complication of chemotherapy treatment and may present as the only clinical sign of infection. If not addressed in a timely manner, it...
Febrile neutropenia is a serious complication of chemotherapy treatment and may present as the only clinical sign of infection. If not addressed in a timely manner, it may progress to multisystem organ failure and may be fatal. Initial assessment of fever in those receiving chemotherapy requires prompt administration of antibiotics, ideally within one hour of presentation. Depending on the clinical status of the patient, antibiotic treatment may occur in the inpatient or outpatient setting. Nurses play an important role in the identification and treatment of patients at high risk for febrile neutropenia through assessment and adherence to clinical practice guidelines. In addition, nurses play an active role in patient education regarding risk factors, protective measures, and signs and symptoms of infection in the immunocompromised oncology patient.
Topics: Humans; Neoplasms; Anti-Bacterial Agents; Fever; Inpatients; Febrile Neutropenia
PubMed: 37021970
DOI: 10.1097/01.NAJ.0000931888.96896.a1 -
Immunity, Inflammation and Disease Dec 2020Graves' disease (GD) is a clinical autoimmune thyroid disease. During the treatment of GD, antithyroid drug-induced agranulocytosis (TIA) is a common and even...
BACKGROUND
Graves' disease (GD) is a clinical autoimmune thyroid disease. During the treatment of GD, antithyroid drug-induced agranulocytosis (TIA) is a common and even life-threatening adverse drug reaction. Previous studies suggested that susceptibility to TIA is strongly associated with HLA-B*27:05, HLA-B*38:02, and HLA-DRB1*08:03 genetic variation and six single nucleotide polymorphisms (SNPs) in MICA genes.
AIMS
The purpose of this study is to further study the associations between TIA, HLA-B and MICA.
MATERIALS & METHODS
We genotyped MICA-STR and MICA-129 variants in 41 TIA and 308 control patients with GD and investigated the linkage effect among SNPs and short tandem repeat (STR) of MICA and HLA-B alleles.
RESULTS
The results showed that MICA*A5.1 was significantly associated with TIA (p = .007, odd ratio = 1.958, 95% confidence interval, 1.192-3.214). In addition, high linkage among MICA-129 and six SNPs MICA and HLA-B was detected, and two haplotypes (AAAACAAAAACGGCCTA and AACAAAAAAAACATTAA (p = 5.14E-07 and p = 3.42E-08, respectively)) were significantly associated with TIA. Furthermore, when we analyzed only MICA-129 and HLA-B separately, the haplotypes (AAAACAAAAAA with p = 2.49E-07 and AACAAAAAAAA with p = 2.14E-09) were identified with more significant effects. MICA-129 was completely linked to six SNPs with haplotypes ACATTACA (p = 2.05E-05) significantly associated with TIA.
CONCLUSION
These data indicated that there was a significant linkage effect between MICA-129 and other alleles, suggesting that they exert interactive effects as risk factors for the development of TIA.
Topics: Adult; Agranulocytosis; Antithyroid Agents; China; Female; HLA-B Antigens; Haplotypes; Humans; Male; Middle Aged; Young Adult
PubMed: 33017098
DOI: 10.1002/iid3.359 -
European Journal of Haematology Jul 2023Asymptomatic neutropenia is a common hematology referral, though standardized reference ranges and published clinical outcomes are lacking. (Review)
Review
BACKGROUND
Asymptomatic neutropenia is a common hematology referral, though standardized reference ranges and published clinical outcomes are lacking.
METHODS
In our retrospective analysis, we evaluated demographics, laboratory, and clinical outcomes of adult patients referred to an academic hematology practice for evaluation of neutropenia from 2010 to 2018. Primary and secondary outcomes included incidence of hematologic disorders and rates of Duffy-null positivity by race, respectively. In a separate analysis, we reviewed absolute neutrophil count (ANC) reference ranges from publicly available Association of American Medical Colleges Medical School Member laboratory directories to assess institutional variations.
RESULTS
In total, 163 patients were included, with disproportionate number of Black patients referred compared to local demographics. Twenty-three percent of patients (n = 38) were found to have a clinically relevant hematologic outcome (mean ANC of 0.59 × 10 /L), and only six were identified with ANC ≥1.0 × 10 /L. Incidence of hematologic outcomes was lowest among Black patients (p = .05), and nearly all Blacks who underwent Duffy-null phenotype testing were positive (93%), compared to 50% of Whites (p = .04). In separate review of laboratory directories, we confirmed wide variation in ANC lower limit of normal (0.91-2.40 × 10 /L).
CONCLUSION
Hematologic disorders were rare in patients with mild neutropenia and among Blacks, highlighting the need to standardize hematological ranges representative of non-White communities.
Topics: Humans; Black or African American; Hematology; Neutropenia; Retrospective Studies; White; Healthcare Disparities
PubMed: 36951011
DOI: 10.1111/ejh.13963 -
The New England Journal of Medicine May 2021
Topics: Animals; CRISPR-Cas Systems; Disease Models, Animal; Gain of Function Mutation; Gene Editing; Hematopoietic Stem Cells; Humans; Leukocyte Elastase; Mice; Mutation; Neutropenia
PubMed: 34010536
DOI: 10.1056/NEJMcibr2102952 -
International Journal of Laboratory... Feb 2022
Topics: Aged; Anemia, Hemolytic, Autoimmune; Humans; Male; Neutropenia; Thrombocytopenia
PubMed: 34228400
DOI: 10.1111/ijlh.13650 -
Expert Opinion on Pharmacotherapy May 2021: Severe neutropenia and infections are potentially life-threatening complications of cytotoxic antineoplastic therapies and often require hospitalization with a severe... (Review)
Review
: Severe neutropenia and infections are potentially life-threatening complications of cytotoxic antineoplastic therapies and often require hospitalization with a severe economic impact. Furthermore, hematological toxicity frequently results in chemotherapy dose reductions and delays that could interfere with disease control.: This review provides an overview of granulocyte colony-stimulating factors (G-CSFs) including pegylated molecules, as well as more recent biosimilar G-CSFs, focusing on the toxicity, pharmacokinetics, and efficacy of these compounds.: The administration of hematopoietic growth factors in primary and secondary prophylaxis of neutropenia is a standard supportive care measure. Recently, several biosimilars have been developed. The market for biosimilar agents seems to be increasing over time thanks to their similar effectiveness and safety, compared with their originators, but lower costs.
Topics: Biosimilar Pharmaceuticals; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Neoplasms; Neutropenia; Polyethylene Glycols; Recombinant Proteins
PubMed: 33579166
DOI: 10.1080/14656566.2021.1873950 -
Cancer Apr 2023
Topics: Humans; Gastrointestinal Microbiome; Neutropenia
PubMed: 36950861
DOI: 10.1002/cncr.34739 -
The Journal of Rheumatology Mar 2023
Topics: Humans; Lupus Erythematosus, Systemic; Neutropenia
PubMed: 36243416
DOI: 10.3899/jrheum.220373 -
Supportive Care in Cancer : Official... Nov 2023Recent clinical practice guidelines have recommended ambulatory management of febrile neutropenia in patients with low risk of complications. Although some centers have... (Review)
Review
PURPOSE
Recent clinical practice guidelines have recommended ambulatory management of febrile neutropenia in patients with low risk of complications. Although some centers have begun developing management protocols for these patients, there appears to be a certain reluctance to implement them in clinical practice. Our aim is to evaluate the strengths and weaknesses of this strategy according to available evidence and to propose new lines of research.
METHODS
Systematic review using a triple aim approach (efficacy, cost-effectiveness, and quality of life), drawing from literature in MEDLINE (PubMed), Embase, and Cochrane Library databases. The review includes studies that assess ambulatory management for efficacy, cost-efficiency, and quality of life.
RESULTS
The search yielded 27 articles that met our inclusion criteria.
CONCLUSION
In conclusion, based on current evidence, ambulatory management of febrile neutropenia is safe, more cost-effective than inpatient care, and capable of improving quality of life in oncological patients with this complication. Ambulatory care seems to be an effective alternative to hospitalization in these patients.
Topics: Humans; Adult; Neoplasms; Fever; Quality of Life; Hospitalization; Febrile Neutropenia
PubMed: 37921996
DOI: 10.1007/s00520-023-08065-y -
The Cochrane Database of Systematic... Nov 2022Intensive cytotoxic chemotherapy for people with cancer can cause severe and prolonged cytopenia, especially neutropenia, a critical condition that is potentially... (Review)
Review
BACKGROUND
Intensive cytotoxic chemotherapy for people with cancer can cause severe and prolonged cytopenia, especially neutropenia, a critical condition that is potentially life-threatening. When manifested by fever and neutropenia, it is called febrile neutropenia (FN). Invasive fungal disease (IFD) is one of the serious aetiologies of chemotherapy-induced FN. In pre-emptive therapy, physicians only initiate antifungal therapy when an invasive fungal infection is detected by a diagnostic test. Compared to empirical antifungal therapy, pre-emptive therapy may reduce the use of antifungal agents and associated adverse effects, but may increase mortality. The benefits and harms associated with the two treatment strategies have yet to be determined. OBJECTIVES: To assess the relative efficacy, safety, and impact on antifungal agent use of pre-emptive versus empirical antifungal therapy in people with cancer who have febrile neutropenia.
SEARCH METHODS
We searched CENTRAL, MEDLINE Ovid, Embase Ovid, and ClinicalTrials.gov to October 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared pre-emptive antifungal therapy with empirical antifungal therapy for people with cancer.
DATA COLLECTION AND ANALYSIS
We identified 2257 records from the databases and handsearching. After removing duplicates, screening titles and abstracts, and reviewing full-text reports, we included seven studies in the review. We evaluated the effects on all-cause mortality, mortality ascribed to fungal infection, proportion of antifungal agent use (other than prophylactic use), duration of antifungal use (days), invasive fungal infection detection, and adverse effects for the comparison of pre-emptive versus empirical antifungal therapy. We presented the overall certainty of the evidence for each outcome according to the GRADE approach.
MAIN RESULTS
This review includes 1480 participants from seven randomised controlled trials. Included studies only enroled participants at high risk of FN (e.g. people with haematological malignancy); none of them included participants at low risk (e.g. people with solid tumours). Low-certainty evidence suggests there may be little to no difference between pre-emptive and empirical antifungal treatment for all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.72 to 1.30; absolute effect, reduced by 3/1000); and for mortality ascribed to fungal infection (RR 0.92, 95% CI 0.45 to 1.89; absolute effect, reduced by 2/1000). Pre-emptive therapy may decrease the proportion of antifungal agent used more than empirical therapy (other than prophylactic use; RR 0.71, 95% CI 0.47 to 1.05; absolute effect, reduced by 125/1000; very low-certainty evidence). Pre-emptive therapy may reduce the duration of antifungal use more than empirical treatment (mean difference (MD) -3.52 days, 95% CI -6.99 to -0.06, very low-certainty evidence). Pre-emptive therapy may increase invasive fungal infection detection compared to empirical treatment (RR 1.70, 95% CI 0.71 to 4.05; absolute effect, increased by 43/1000; very low-certainty evidence). Although we were unable to pool adverse events in a meta-analysis, there seemed to be no apparent difference in the frequency or severity of adverse events between groups. Due to the nature of the intervention, none of the seven RCTs could blind participants and personnel related to performance bias. We identified considerable clinical and statistical heterogeneity, which reduced the certainty of the evidence for each outcome. However, the two mortality outcomes had less statistical heterogeneity than other outcomes.
AUTHORS' CONCLUSIONS
For people with cancer who are at high-risk of febrile neutropenia, pre-emptive antifungal therapy may reduce the duration and rate of use of antifungal agents compared to empirical therapy, without increasing over-all and IFD-related mortality; but the evidence regarding invasive fungal infection detection and adverse events was inconsistent and uncertain.
Topics: Humans; Antifungal Agents; Febrile Neutropenia; Invasive Fungal Infections; Neoplasms; Randomized Controlled Trials as Topic
PubMed: 36440894
DOI: 10.1002/14651858.CD013604.pub2