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Substantial improvements have occurred in the management of infectious disease in patients with cancer. It is now unusual for patients with acute leukemia who receive their initial induction chemotherapy at a major center to die of infectious complications. Many patients will undergo further therapy that leads to prolonged periods of neutropenia without succumbing to a major infectious complication. However, managing infections in neutropenic patients remains a dynamic process, affected by the appearance of new pathogens, the emergence of antibiotic-resistant organisms, and the improved stratification of patients' infection risk. All of these factors have fostered new treatment approaches. These NCCN clinical guidelines address many of the day-to-day issues inherent in managing fever and neutropenia.

For the most recent version of the guidelines, please visit

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Jeffrey Crawford, David C. Dale, Nicole M. Kuderer, Eva Culakova, Marek S. Poniewierski, Debra Wolff, and Gary H. Lyman

. Talcott JA Siegel RD Finberg R Goldman L . Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule . J Clin Oncol 1992 ; 148 : 2561 – 2568 . 2. Kuderer NM Dale DC Crawford JC

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Brahm H. Segal and Alison G. Freifeld

2006 ; 85 : 424 – 433 . 20. Tamura K . Clinical guidelines for the management of neutropenic patients with unexplained fever in Japan: validation by the Japan Febrile Neutropenia Study Group . Int J Antimicrob Agents 2005 ; 26 ( Suppl 2

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Thomas A. Cumbo and Brahm H. Segal

persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group . N Engl J Med 1999 ; 340 : 764 – 771 47 Bowden R Chandrasekar P White MH . A double-blind, randomized, controlled trial of

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Jeffrey Crawford, James Armitage, Lodovico Balducci, Charles Bennett, Douglas W. Blayney, Spero R. Cataland, David C. Dale, George D. Demetri, Harry P. Erba, James Foran, Alison G. Freifeld, Marti Goemann, Mark L. Heaney, Sally Htoy, Susan Hudock, Dwight D. Kloth, David J. Kuter, Gary H. Lyman, Laura Boehnke Michaud, Sarah C. Miyata, Martin S. Tallman, Saroj Vadhan-Raj, Peter Westervelt, and Michael K. Wong

granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer . N Engl J Med 1991 ; 325 : 164 – 170 . 11 Gatzemeier U Kleisbauer JP Drings P . Lenograstim as support for ACE

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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

administered G-CSF normalized neutrophils in most patients and prevented fever, mouth ulcers, and infections. Subsequent observation studies show that patients with idiopathic and cyclic neutropenia generally respond to low-dose daily, alternate-day, or thrice

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Douglas W. Blayney, Nicole M. Kuderer, Alice Kate Cummings Joyner, John Jarvis, Dominic Nunag, Jasmine Wells, Lan Huang, Ramon Monhanlal, and Gary H. Lyman

Background Patients with breast cancer treated with myelosuppressive chemotherapy are at an increased risk of developing febrile neutropenia (FN), a medical emergency characterized by the occurrence of fever during a period of significant

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Nicolas C. Issa and Lindsey R. Baden

-old man with multiple myeloma 10 months after allogeneic hematopoietic cell transplantation who presented with fevers, cough, headaches, and myalgia. He had received the trivalent influenza vaccine 1 month before admission (pandemic 2009 H1N1 vaccine was

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Anna M. Gibson and Claire Sutherby

immediately on noticing a fever. Patients were given a pocket card stating that the patient had recently received chemotherapy, indicating the patient’s neutropenia risk, and listing directions to a newly created febrile neutropenia page on the health system

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Deborah S. Yolin-Raley, Ibiayi Dagogo-Jack, Heidi B. Niell, Robert J. Soiffer, Joseph H. Antin, Edwin P. Alyea III, and Brett E. Glotzbecker

Background Most patients treated with myeloablative conditioning regimens before hematopoietic stem cell transplantation (HSCT) develop neutropenic fevers in the pre-engraftment period because of profound neutropenia. 1 , 2 Fevers may signify