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

• Published in: Supportive care in cancer Vol. 25; no. 11; pp. 3515 - 3521
• Main Authors: Kimura, Shun-ichi, Fujita, Hiroyuki, Kato, Hideaki, Hiramoto, Nobuhiro, Hosono, Naoko, Takahashi, Tsutomu, Shigeno, Kazuyuki, Hatsumi, Naoko, Minamiguchi, Hitoshi, Miyatake, Junichi, Handa, Hiroshi, Akiyama, Nobu, Kanda, Yoshinobu, Yoshida, Minoru, Kiyoi, Hitoshi, Miyazaki, Yasushi, Naoe, Tomoki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2017; Springer; Springer Nature B.V
• Subjects: Acute Disease; Acute leukemia; Adults; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antifungal agents; Antimicrobial agents; Antineoplastic agents; Cancer research; Care and treatment; Chemotherapy; Disease management; Female; Granulocytes; Health aspects; Humans; Infection - etiology; Infection - pathology; Infection - therapy; Japan; Leukemia; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - pathology; Male; Medicine; Medicine & Public Health; Neutropenia; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Questionnaires; Rehabilitation Medicine; Surveys; Surveys and Questionnaires; Japan; Acute leukemia; Antimicrobial prophylaxis; Infectious complication; Empirical therapy; Japan Adult Leukemia Study Group; Febrile neutropenia
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-017-3775-8

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.