Review of the ASCO and IDSA clinical practice guidelines on antimicrobial prophylaxis for adult patients with cancer-related immunosupression

Abstract

Patients undergoing cytotoxic chemotherapy and hematopoietic stem-cell transplantation are at risk for infection. The risk of infections increases with the depth and duration of neutropenia, with the greatest risk occurring in patients who experience profound, prolonged neutropenia after chemotherapy, which is most likely to occur in the period before engraftment during hematopoietic stem-cell transplantation and after induction chemotherapy for acute leukemia, as well as in other situations that are accompanied by deep long-term neutropenia. Those patients represent a high-risk group for which antimicrobial prophylaxis is recommended. The updated version of the recommendations developed by the American Society of Clinical Oncology (ASCO) and the Infectious Diseases Society of America (IDSA) includes the information on antibacterial, antifungal, and antiviral prophylaxis in this patient population. The article includes a comparative analysis of some other published international guidelines on this topic, including the US National Comprehensive Cancer Network (NCCN) for the Prevention and Treatment of Cancer-Related Infections and the European Conference on Infections in Patients with Leukemia (ECIL) for primary antifungal prophylaxis in adult patients with hematological malignancies.

Keywords

• prophylaxis
• neutropenia
• malignancy
• antimicrobials