Chiodo-Reidy Jessica, Slavin Monica A, Tio Shio Yen, Ng Gywneth, Bajel Ashish, Thursky Karin A, Douglas Abby P
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Open Forum Infect Dis. 2024 Aug 27;11(9):ofae488. doi: 10.1093/ofid/ofae488. eCollection 2024 Sep.
Many patients with hematological malignancy develop fever after chemotherapy/conditioning but before chemotherapy-induced neutropenia (preneutropenic fever [PNF]). The proportion of PNF with an infectious etiology is not well established.
We conducted a single-center, prospective observational substudy of PNF (neutrophils >0.5 cells/μL, ≥38.0°C) in adults receiving acute myeloid leukemia (AML) chemotherapy, or allogeneic hematopoietic cell transplant (allo-HCT) conditioning enrolled in a neutropenic fever randomized controlled trial between 1 January and 31 October 2018. Eligible patients had anticipated neutropenia ≥10 days and exclusions included concurrent infection and/or neutropenia prior to chemotherapy or conditioning. PNF rates and infections encountered were described. Associations between noninfectious etiologies and fever were explored. Antimicrobial therapy prescription across preneutropenic and neutropenic periods was examined.
Of 62 consecutive patients included (43 allo-HCT, 19 AML), 27 had PNF (44%) and 5 (19%) had an infective cause. Among allo-HCT, PNF occurred in 14 of 17 (82%) who received thymoglobulin; only 1 of 14 (7%) had infection. During AML chemotherapy, 18 of 19 received cytarabine, of which 8 of 18 (44%) had PNF and 3 of 8 (38%) had infection. Most patients with PNF had antimicrobial therapy continued into the neutropenic period (19/27 [70%]). Those with PNF were more likely to be escalated to broader antimicrobial therapy at onset/during neutropenic fever (5/24 [21%] vs 2/30 [7%]).
Rates of PNF were high, and documented infection low, leading to prolonged and escalating antimicrobial therapy. In the absence of infection, early cessation of empiric therapy after PNF is recommended as an important stewardship intervention.
许多血液系统恶性肿瘤患者在化疗/预处理后、化疗引起的中性粒细胞减少之前（即中性粒细胞减少前期发热[PNF]）出现发热。感染性病因导致的PNF比例尚未明确。
我们对2018年1月1日至10月31日期间参加中性粒细胞减少发热随机对照试验的接受急性髓系白血病（AML）化疗或异基因造血细胞移植（allo-HCT）预处理的成人患者进行了一项单中心前瞻性观察性亚研究，研究对象为PNF（中性粒细胞>0.5×10⁹/L，体温≥38.0°C）。符合条件的患者预计中性粒细胞减少持续≥10天，排除标准包括化疗或预处理前并发感染和/或中性粒细胞减少。描述了PNF发生率和所遇到的感染情况。探讨了非感染性病因与发热之间的关联。检查了中性粒细胞减少前期和中性粒细胞减少期的抗菌治疗处方。
纳入的62例连续患者中（43例allo-HCT，19例AML），27例发生PNF（44%），5例（19%）有感染性病因。在allo-HCT患者中，17例接受胸腺球蛋白治疗的患者中有14例（82%）发生PNF；14例中仅1例（7%）有感染。在AML化疗期间，19例中有18例接受阿糖胞苷治疗，其中18例中的8例（44%）发生PNF，8例中的3例（38%）有感染。大多数PNF患者的抗菌治疗持续到中性粒细胞减少期（19/27[70%]）。PNF患者在中性粒细胞减少前期发热开始时/期间更有可能升级为更广泛的抗菌治疗（5/24[21%]对2/30[7%]）。
PNF发生率高，记录的感染率低，导致抗菌治疗时间延长且升级。在无感染的情况下，建议在PNF后尽早停止经验性治疗，作为一项重要的管理干预措施。
