Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update

Thomas Lehrnbecher, Paula Robinson, Brian Fisher, Sarah Alexander, Roland A. Ammann, Melissa Beauchemin, Fabianne Carlesse, Andreas H. Groll, Gabrielle M. Haeusler, Maria Santolaya, William J. Steinbach, Elio Castagnola, Bonnie L. Davis, L. Lee Dupuis, Aditya H. Gaur, Wim J.E. Tissing, Theo Zaoutis, Robert Phillips, Lillian Sung*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Pages (from-to)2082-2094
Number of pages13
JournalJournal of Clinical Oncology
Issue number18
Early online date1 May 2017
Publication statusPublished - 20 Jun 2017

Cite this