Management of fever and neutropenia in the adult patient with acute myeloid leukemia.
Expert Rev Anti Infect Ther. 2020 Sep 07;:
Authors: Peseski AM, McClean M, Green SD, Beeler C, Konig H
INTRODUCTION: Febrile neutropenia represents one of the most common treatment-associated complications in the management of acute myeloid leukemia (AML) and is considered an oncologic emergency. Rapid and detailed workup as well as the initiation of empiric broad-spectrum antibiotic therapy is critical to avoid sepsis and to reduce mortality. Although a definitive source of infection is frequently not identified, the severely immunosuppressed status of the AML patient undergoing cytotoxic therapy results in a high risk for a wide array of bacterial, fungal and viral etiologies.
AREAS COVERED: The authors herein review the diagnostic and therapeutic approach to the neutropenic leukemia patient based on the current knowledge. Special consideration is given to the rapidly changing therapeutic landscape in AML, creating new challenges in the management of infectious complications. For review of the current literature, Pubmed database was searched with articles from 1970-2020. Articles were searched based upon guidelines for treatment, pathogens, prophylaxis, management, and therapeutic landscape for the neutropenic patient with acute myelogenous leukemia.
EXPERT OPINION: Multidrug resistant organisms pose a major challenge in the management of neutropenic fever patients with hematologic malignancies - including AML. Future directions to improve outcomes demand innovative treatment approaches as well as advances in biomarker research to facilitate diagnosis and disease monitoring. Recent achievements in AML-targeted therapy led to an increased incidence of differentiation syndrome, a potentially life-threatening side effect that frequently resembles clinical infection and requires prompt recognition and aggressive intervention.
PMID: 32892669 [PubMed - as supplied by publisher]