TY - JOUR
T1 - Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients
T2 - 2017 update
AU - Lehrnbecher, Thomas
AU - Robinson, Paula
AU - Fisher, Brian
AU - Alexander, Sarah
AU - Ammann, Roland A.
AU - Beauchemin, Melissa
AU - Carlesse, Fabianne
AU - Groll, Andreas H.
AU - Haeusler, Gabrielle M.
AU - Santolaya, Maria
AU - Steinbach, William J.
AU - Castagnola, Elio
AU - Davis, Bonnie L.
AU - Dupuis, L. Lee
AU - Gaur, Aditya H.
AU - Tissing, Wim J.E.
AU - Zaoutis, Theo
AU - Phillips, Robert
AU - Sung, Lillian
PY - 2017/6/20
Y1 - 2017/6/20
N2 - Purpose: To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. Methods: The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Results: Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion: Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.
AB - Purpose: To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. Methods: The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Results: Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion: Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.
UR - http://www.scopus.com/inward/record.url?scp=85021739569&partnerID=8YFLogxK
U2 - 10.1200/JCO.2016.71.7017
DO - 10.1200/JCO.2016.71.7017
M3 - Review article
C2 - 28459614
AN - SCOPUS:85021739569
SN - 0732-183X
VL - 35
SP - 2082
EP - 2094
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 18
ER -