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Prevention and Treatment of Cancer-Related Infections

Memorial Sloan-Kettering Cancer Center

Infectious diseases are important causes of morbidity and mortality in patients with cancer. In certain instances, the malignancy itself can predispose patients to severe or recurrent infections. Neutropenia has been recognized for many decades as a major risk factor, and effective strategies to anticipate, prevent, and manage infectious complications in patients with cancer experiencing neutropenia have led to improved outcomes. Reflecting the heterogeneity of immunocompromised conditions in patients with cancer and the spectrum of pathogens to which they are susceptible, NCCN expanded the scope of the Fever and Neutropenia Panel in 2007 to create guidelines on Prevention and Treatment of Cancer-Related Infections. These guidelines, newly updated for 2008, characterize major categories of immunologic deficits in persons with cancer and the major pathogens to which they are susceptible.

For the most recent version of the guidelines, please visit NCCN.org

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Myeloid Growth Factors Clinical Practice Guidelines in Oncology

Chemotherapy-induced neutropenia is the major dose-limiting toxicity of systemic cancer chemotherapy, associated with substantial morbidity, mortality, and cost. Although prophylactic colony-stimulating factors (CSFs), can reduce this complication, their routine use in all patients on myelosuppressive chemotherapy is prohibitively costly. Selective use in patients most at risk for neutropenia may enhance cost-effectiveness, but determining the actual risk is complicated by issues in reporting myelosuppression and dose intensity, among other factors. For this reason, NCCN experts developed these guidelines to assist practitioners in the appropriate prophylactic use of CSFs.

For the most recent version of the guidelines, please visit NCCN.org

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BRAF/MEK Dual Inhibitors Therapy in Progressive and Anaplastic Pleomorphic Xanthoastrocytoma: Case Series and Literature Review

Karolina Kata, Juan C. Rodriguez-Quintero, Octavio D. Arevalo, Jackie J. Zhang, Meenakshi Bidwai Bhattacharjee, Cornelius Ware, Antonio Dono, Roy Riascos-Castaneda, Nitin Tandon, Angel Blanco, Yoshua Esquenazi, Leomar Y. Ballester, Mark Amsbaugh, Arthur L. Day, and Jay-Jiguang Zhu

vemurafenib and cobimetinib for 28 and 29 months, respectively—except for short breaks (18 and 10 days, respectively) due to rash and neutropenia—without clinical or radiologic changes ( Figure 1M, N ). Results of pathology, NGS, and partial MRI were published

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Retrospective Analysis of Treatment Patterns and Effectiveness of Palbociclib and Subsequent Regimens in Metastatic Breast Cancer

Jing Xi, Aabha Oza, Shana Thomas, Foluso Ademuyiwa, Katherine Weilbaecher, Rama Suresh, Ron Bose, Mathew Cherian, Leonel Hernandez-Aya, Ashley Frith, Lindsay Peterson, Jingqin Luo, Jairam Krishnamurthy, and Cynthia X. Ma

neutropenia were collected and graded according to NCI Common Terminology Criteria for Adverse Events, version 4.1. Grade 1 neutropenia occurred in 15.5% of the patients (n=31), grade 2 in 31.5% (n=63), grade 3 in 38.5% (n=77), and grade 4 in 3% (n=6). Dose

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Myeloid Growth Factor Guidelines: Moving Toward a Societal Perspective

Rodger J. Winn

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Erratum

-897 ), the first node in the “Yes” pathway for “Significant concerns about alopecia or neutropenia” should have read, “Platinum/ pemetrexed + bevacizumab” (page 894). The editorial office apologizes for this error. A corrected copy of the editorial is

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Moving Forward With Myeloid Growth Factors

Jeffrey Crawford

, the NCCN Guidelines Panel initially established the febrile neutropenia threshold for use of myeloid growth factors at 20%; this standard has now been adopted by virtually all other guidelines committees. Moreover, it was the NCCN Panel who stressed

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Myeloid Growth Factors

Jeffrey Crawford, Jeffrey Allen, James Armitage, Douglas W. Blayney, Spero R. Cataland, Mark L. Heaney, Sally Htoy, Susan Hudock, Dwight D. Kloth, David J. Kuter, Gary H. Lyman, Brandon McMahon, David P. Steensma, Saroj Vadhan-Raj, Peter Westervelt, and Michael Westmoreland

Overview Neutropenia (< 500 neutrophils/mcL or < 1000 neutrophils/mcL and a predicted decline to < 500/mcL over the next 48 hours) and resulting febrile neutropenia (≥ 38.3°C orally or ≥ 38.0°C over 1 hour) can be induced by myelosuppressive

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Point: Fluoroquinolone-Based Antibacterial Chemoprophylaxis in Neutropenic Cancer Patients Works for Defined Outcomes in Defined Populations, but Must Be Used Wisely

Eric J. Bow

neutropenia and fever] . Rev Esp Quimioter 2001 ; 14 : 75 – 83 . 3 Hughes WT Armstrong D Bodey GP . 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer . Clin Infect Dis 2002 ; 34 : 730 – 751 . 4

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CLO22-037: Tumor Lysis Syndrome and Infectious Complications During Induction With Venetoclax Combined With Azacitidine or Decitabine in Patients With Acute Myeloid Leukemia

Sankalp Arora, Carl Zainaldin, Srilakshmi Bathini, Udita Gupta, Sarah Worth, Kimo Bachiashvili, Ravi Bhatia, Kelly Godby, Omer Jamy, Sravanti Rangaraju, Barry Diamond, Josh D. Oliver, Donna Salzman, Antonio Di Stasi, and Pankit Vachhani

in those who developed TLS. No significant association was found between Ven ramp up and TLS incidence. 42(37.8%) had known infections prior to starting HMA+Ven. 41 patients (36.9%) were diagnosed with febrile neutropenia; 36 (32.4%) had confirmed