SpringerLink
Log in

Management of infection during chemotherapy for acute leukemia in Japan: a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

We performed a nationwide questionnaire-based survey to evaluate the current clinical practices of infectious complications during chemotherapy for acute leukemia in Japan.

Methods

We e-mailed a questionnaire to member institutions of the Japan Adult Leukemia Study Group in September, 2013. The questionnaire consisted of 50 multiple-choice questions covering therapeutic environment, antimicrobial prophylaxis, screening test during neutropenia, empirical therapy for febrile neutropenia, and the use of granulocyte-colony stimulating factor. The results were compared to those of previous surveys conducted in 2001 and 2007, and also to the recommendations described in the guidelines.

Results

Usable responses were received from 141 out of 222 (63.5%) institutions. Chemotherapy for acute myeloid leukemia was performed in protective environment in 90% of the institutions, which increased compared to previous survey (76%). Fluoroquinolones and fluconazole were the most commonly used antimicrobial agents for antibacterial and antifungal prophylaxis, followed by sulfamethoxazole-trimethoprim and itraconazole, respectively. In empirical therapy for febrile neutropenia, monotherapy with β-lactum antibiotics was the first-line therapy in most of the institutions. While empirical antifungal therapy was adopted for persistent fever in more than half of the institutions, preemptive/presumptive therapy was also used in approximately 40% of the institutions. Most of the clinicians were reluctant to use granulocyte-colony stimulating factor routinely in chemotherapy for acute myeloid leukemia.

Conclusions

This study clarified the current clinical practices of infectious complications during chemotherapy for acute leukemia and would provide important information for the development of a suitable guideline in Japan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Japanese Society of Medical Oncology (2012) Practical guideline of febrile neutropenia (FN). Nankodo CO., Ltd., Tokyo

    Google Scholar 

  2. Baer MR, Bernstein SH, Brunetto VL, Heinonen K, Mrozek K, Swann VL, Minderman H, Block AW, Pixley LA, Christiansen NP, Fay JW, Barcos M, Rustum Y, Herzig GP, Bloomfield CD (1996) Biological effects of recombinant human granulocyte colony-stimulating factor in patients with untreated acute myeloid leukemia Blood 87: 1484–1494

  3. Cometta A, Kern WV, De Bock R, Paesmans M, Vandenbergh M, Crokaert F, Engelhard D, Marchetti O, Akan H, Skoutelis A, Korten V, Vandercam M, Gaya H, Padmos A, Klastersky J, Zinner S, Glauser MP, Calandra T, Viscoli C, International Antimicrobial Therapy Group of the European Organization for Research Treatment of C (2003) Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy Clin Infect Dis 37: 382–389

    Article  CAS  Google Scholar 

  4. Erjavec Z, de Vries-Hospers HG, Laseur M, Halie RM, Daenen S (2000) A prospective, randomized, double-blinded, placebo-controlled trial of empirical teicoplanin in febrile neutropenia with persistent fever after imipenem monotherapy. J Antimicrob Chemother 45:843–849

    Article  CAS  Google Scholar 

  5. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad, II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of A (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious Diseases Society of America Clin Infect Dis 52: e56–e93

  6. Fujita H, Yoshida M, Miura K, Sano T, Kito K, Takahashi M, Shigeno K, Kanda Y, Akiyama N, Hatsumi N, Ohnishi K, Miyawaki S, Naoe T (2009) Management of infection in patients with acute leukemia during chemotherapy in Japan: questionnaire analysis by the Japan Adult Leukemia Study Group. Int J Hematol 90:191–198

    Article  Google Scholar 

  7. Gafter-Gvili A, Fraser A, Paul M, Leibovici L (2005) Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 142:979–995

    Article  Google Scholar 

  8. Heil G, Hoelzer D, Sanz MA, Lechner K, Liu Yin JA, Papa G, Noens L, Szer J, Ganser A, O'Brien C, Matcham J, Barge A (1997) A randomized, double-blind, placebo-controlled, phase III study of filgrastim in remission induction and consolidation therapy for adults with de novo acute myeloid leukemia. The International Acute Myeloid Leukemia Study Group Blood 90:4710–4718

    CAS  Google Scholar 

  9. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  Google Scholar 

  10. Hughes WT, Armstrong D, Bodey GP, Brown AE, Edwards JE, Feld R, Pizzo P, Rolston KV, Shenep JL, Young LS (1997) 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America Clin Infect Dis 25:551–573

    Article  CAS  Google Scholar 

  11. Hughes WT, Armstrong D, Bodey GP, Feld R, Mandell GL, Meyers JD, Pizzo PA, Schimpff SC, Shenep JL, Wade JC, et al. (1990) From the Infectious Diseases Society of America. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever J Infect Dis 161: 381–396

    Article  CAS  Google Scholar 

  12. Kern WV, Klose K, Jellen-Ritter AS, Oethinger M, Bohnert J, Kern P, Reuter S, von Baum H, Marre R (2005) Fluoroquinolone resistance of Escherichia coli at a cancer center: epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia Eur J Clin Microbiol Infect Dis 24: 111–118

    Article  CAS  Google Scholar 

  13. Maertens J, Theunissen K, Verhoef G, Verschakelen J, Lagrou K, Verbeken E, Wilmer A, Verhaegen J, Boogaerts M, Van Eldere J (2005) Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study Clin Infect Dis 41: 1242–1250

    Article  CAS  Google Scholar 

  14. Marchetti O, Lamoth F, Mikulska M, Viscoli C, Verweij P, Bretagne S (2012) ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients Bone Marrow Transplant 47: 846–854

    Article  Google Scholar 

  15. Masaoka T (2004) Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary Clin Infect Dis 39 Suppl 1: S49-52

    Article  Google Scholar 

  16. Morrissey CO, Chen SC, Sorrell TC, Milliken S, Bardy PG, Bradstock KF, Szer J, Halliday CL, Gilroy NM, Moore J, Schwarer AP, Guy S, Bajel A, Tramontana AR, Spelman T, Slavin MA (2013) Galactomannan and PCR versus culture and histology for directing use of antifungal treatment for invasive aspergillosis in high-risk haematology patients: a randomised controlled trial Lancet Infect Dis 13: 519–528

    Article  CAS  Google Scholar 

  17. Oshima K, Kanda Y, Asano-Mori Y, Nishimoto N, Arai S, Nagai S, Sato H, Watanabe T, Hosoya N, Izutsu K, Asai T, Hangaishi A, Motokura T, Chiba S, Kurokawa M (2007) Presumptive treatment strategy for aspergillosis in allogeneic haematopoietic stem cell transplant recipients. J Antimicrob Chemother 60:350–355

    Article  CAS  Google Scholar 

  18. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE (2016) Sobel JD (2016) clinical practice guideline for the management of candidiasis. Update by the Infectious Diseases Society of America Clin Infect Dis 62:e1–50

    Article  Google Scholar 

  19. Tamura K (2005) 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 26 Suppl 2: S123-127; discussion S133-140

    Article  Google Scholar 

  20. Tamura K, Akiyama N, Kanda Y, Saito M (2015) Efficacy and safety of tazobactam/piperacillin as an empirical treatment for the patients of adult and child with febrile neutropenia in Japan J Infect Chemother 21: 654–662

    Article  CAS  Google Scholar 

  21. Usuki K, Urabe A, Masaoka T, Ohno R, Mizoguchi H, Hamajima N, Miyazaki T, Niitsu Y, Yoshida Y, Miura A, Shibata A, Abe T, Miura Y, Ikeda Y, Nomura T, Nagao T, Saitou H, Shirakawa S, Ohkuma M, Matsuda T, Nakamura T, Horiuchi A, Kuramoto A, Kimura I, Irino S, Niho Y, Takatsuki K, Tomonaga M, Uchino H, Takaku F, Gran AMLSG (2002) Efficacy of granulocyte colony-stimulating factor in the treatment of acute myelogenous leukaemia: a multicentre randomized study Br J Haematol 116: 103–112

    Article  CAS  Google Scholar 

  22. Yoshida M, Akiyama N, Fujita H, Miura K, Miyatake J, Handa H, Kito K, Takahashi M, Shigeno K, Kanda Y, Hatsumi N, Ohtake S, Sakamaki H, Ohnishi K, Miyawaki S, Ohno R, Naoe T (2011) Analysis of bacteremia/fungemia and pneumonia accompanying acute myelogenous leukemia from 1987 to 2001 in the Japan Adult Leukemia Study Group. Int J Hematol 93:66–73

    Article  Google Scholar 

  23. Yoshida M, Ohno R (2004) Antimicrobial prophylaxis in febrile neutropenia Clin Infect Dis 39 Suppl 1: S65-67

    Article  CAS  Google Scholar 

  24. Yoshida M, Ohno R (2004) Current antimicrobial usage for the management of infections in leukemic patients in Japan: results of a survey Clin Infect Dis 39 Suppl 1: S11-14

    Article  Google Scholar 

Download references

Acknowledgements

This work is supported in part by a grant from Japan Adult Leukemia Study Group.

Author information

Authors and Affiliations

  1. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Shun-ichi Kimura & Yoshinobu Kanda

  2. Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan

    Hiroyuki Fujita

  3. Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Hideaki Kato

  4. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan

    Nobuhiro Hiramoto

  5. Department of Hematology and Oncology, University of Fukui, Fukui, Japan

    Naoko Hosono

  6. Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan

    Tsutomu Takahashi

  7. Department of Hematology, Hamamatsu Medical Center, Hamamatsu, Japan

    Kazuyuki Shigeno

  8. Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan

    Naoko Hatsumi

  9. Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, Japan

    Hitoshi Minamiguchi

  10. Department of Hematology, Sakai Hospital Kinki University Faculty of Medicine, Sakai, Japan

    Junichi Miyatake

  11. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan

    Hiroshi Handa

  12. Department of Hematology/Oncology, Teikyo University School of Medicine, Tokyo, Japan

    Nobu Akiyama

  13. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  14. Fourth Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi hospital, Kawasaki, Japan

    Minoru Yoshida

  15. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Hitoshi Kiyoi

  16. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Yasushi Miyazaki

  17. National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    Tomoki Naoe

Authors
  1. Shun-ichi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyuki Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideaki Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuhiro Hiramoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naoko Hosono
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsutomu Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuyuki Shigeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naoko Hatsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hitoshi Minamiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Junichi Miyatake
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroshi Handa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nobu Akiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yoshinobu Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Minoru Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hitoshi Kiyoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yasushi Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tomoki Naoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Japan Adult Leukemia Study Group (JALSG)

Corresponding author

Correspondence to Hiroyuki Fujita.

Ethics declarations

Conflict of interest

Shun-ichi Kimura received honoraria from Pfizer, Astellas, Sumitomo Dainippon Pharma, and Nippon Kayaku. Hiroyuki Fujita received honoraria from Novartis and payment for manuscripts from Chugai Pharmaceutical. Tsutomu Takahashi received grants from Chugai Pharmaceutical, Kyowa Hakko Kirin, and Astellas, and honoraria from Chugai Pharmaceutical, Kyowa Hakko Kirin, Taiho Pharmaceutical, and Celgene Corporation. Hiroshi Handa received payment for consultancy from Takeda Pharmaceutical, grants, and honoraria from Kyowa Hakko Kirin, Chugai Pharmaceutical, Takeda Pharmaceutical, Novartis, Bristol-Myers Squibb, Ono Pharmaceutical, and Astellas. Nobu Akiyama received grants from Shionogi, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Astellas, and payment for manuscripts from Taiho Pharmaceutical. Yoshinobu Kanda received grants from Astellas, Chugai Pharmaceutical, Kyowa Hakko Kirin, Shionogi, Sumitomo Dainippon Pharma, Pfizer, and Taisho Toyama Pharmaceutical, and honoraria from Pfizer, MSD, Astellas, Sumitomo Dainippon Pharma, and Kyowa Hakko Kirin. Minoru Yoshida received honoraria from Astellas, Sumitomo Dainippon Pharma, and MSD. Hitoshi Kiyoi received research funding from Chugai Pharmaceutical, Bristol-Myers Squibb, Kyowa Hakko Kirin, Zenyaku Kogyo, FUJIFILM Corporation, Nippon Boehringer Ingelheim, Astellas, and Celgene Corporation, consulting fees from Astellas and Daiichi Sankyo, and honoraria from Bristol-Myers Squibb and Pfizer. Yasushi Miyazaki received grants from Chugai Pharmaceutical, Kyowa Hakko Kirin, Astellas, and Novartis, and honoraria from Chugai Pharmaceutical, Kyowa Hakko Kirin, Astellas, Sumitomo Dainippon Pharma, Celgene Corporation, and Novartis. Other authors: none to declare.

Electronic supplementary material

ESM 1

(DOC 335 kb)

ESM 2

(DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimura, Si., Fujita, H., Kato, H. et al. Management of infection during chemotherapy for acute leukemia in Japan: a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group. Support Care Cancer 25, 3515–3521 (2017). https://doi.org/10.1007/s00520-017-3775-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-017-3775-8

Keywords

Search

Navigation