Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update.

Autor:	Lehrnbecher T; Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany., Robinson PD; Pediatric Oncology Group of Ontario, Toronto, Canada., Ammann RA; Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.; Kinderaerzte KurWerk, Burgdorf, Switzerland., Fisher B; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA., Patel P; Pediatric Oncology Group of Ontario, Toronto, Canada.; Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada., Phillips R; Department of Haematology and Oncology, Leeds Teaching Hospital, NHS Trust, Leeds, United Kingdom., Beauchemin MP; Columbia University/Herbert Irving Cancer Center, Columbia University School of Nursing, New York, NY., Carlesse F; Pediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo, Brazil., Castagnola E; Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy., Davis BL; Not applicable (patient representative)., Elgarten CW; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA., Groll AH; Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany., Haeusler GM; Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Australia.; Department of Infectious Diseases, Peter MacCallum Cancer Center, Melbourne, Australia.; NHMRC National Center for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia., Koenig C; Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.; Kinderaerzte KurWerk, Burgdorf, Switzerland., Santolaya ME; Department of Pediatrics, Hospital Dr Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile., Tissing WJE; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.; Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands., Wolf J; Division of Infectious Disease, St Jude Children's Research Hospital, Memphis, TN.; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN., Alexander S; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada., Hu H; Pediatric Oncology Group of Ontario, Toronto, Canada.; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada., Dupuis LL; Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada., Sung L; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Mar 20; Vol. 41 (9), pp. 1774-1785. Date of Electronic Publication: 2023 Jan 23.
DOI:	10.1200/JCO.22.02224
Abstrakt:	Purpose: To update a clinical practice guideline (CPG) for the empiric management of fever and neutropenia (FN) in pediatric patients with cancer and hematopoietic cell transplantation recipients. Methods: The International Pediatric Fever and Neutropenia Guideline Panel reconvened to conduct the second update of this CPG. We updated the previous systematic review to identify new randomized controlled trials (RCTs) evaluating any strategy for the management of FN in pediatric patients. Using the Grading of Recommendations Assessment, Development and Evaluation framework, evidence quality was classified as high, moderate, low, or very low. The panel updated recommendations related to initial management, ongoing management, and empiric antifungal therapy. Changes from the 2017 CPG were articulated, and good practice statements were considered. Results: We identified 10 new RCTs in addition to the 69 RCTs identified in previous FN CPGs to inform the 2023 FN CPG. Changes from the 2017 CPG included two conditional recommendations regarding (1) discontinuation of empiric antibacterial therapy in clinically well and afebrile patients with low-risk FN if blood cultures remain negative at 48 hours despite no evidence of marrow recovery and (2) pre-emptive antifungal therapy for invasive fungal disease in high-risk patients not receiving antimold prophylaxis. The panel created a good practice statement to initiate FN CPG-consistent empiric antibacterial therapy as soon as possible in clinically unstable febrile patients. Conclusion: The updated FN CPG incorporates important modifications on the basis of recently published trials. Future work should focus on addressing knowledge gaps, improving CPG implementation, and measuring the impact of CPG-consistent care.
Databáze:	MEDLINE
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