Antiviral Prophylaxis Now Recommended for Some Cancer Patients


By Reuters Staff

NEW YORK (Reuters Health) - Updated guidelines on antimicrobial prophylaxis for immunosuppressed cancer patients from the American Society of Clinical Oncology (ASCO) and the Infectious Disease Society of America (ISDA) now include recommendations on antiviral prophylaxis and vaccination.

"Updated systematic reviews and meta-analyses and new single studies did not include any new information that would alter the recommendations for antibiotic and antifungal prophylaxis included in the previous version of this review," Dr. Randy A. Taplitz of UC San Diego Health in La Jolla and colleagues write in the Journal of Clinical Oncology, online September 4.

The systematic review includes six new or updated meta-analyses and six primary studies not included in the previous version of the guidelines, published in 2013.

Prolonged neutropenia can occur after chemotherapy, especially during the pre-engraftment phase of hematopoietic stem-cell transplantation (HSCT) and in patients with acute leukemia undergoing induction chemotherapy, the authors note. While fever is a key indicator of infection, they add, patients with severe neutropenia may present without fever or in a hypothermic state.

"Prevention and appropriate management of febrile neutropenia (FN) is important because the rate of major complications (eg, hypotension, acute renal, respiratory, or heart failure) in the context of FN is approximately 25% to 30% and mortality up to 11%."

The guidelines recommend fluoroquinolone prophylaxis and antifungal prophylaxis with oral triazole or parenteral echinocandin for patients at high risk of FN or "profound, protracted neutropenia" during the period of expected neutropenia.

Patients with a risk of invasive aspergillosis above 6% - for example, those with acute myeloid leukemia/myelodysplastic syndrome or those undergoing graft-versus-host disease (GVHD) treatment - should receive a mold-active triazole, the authors say.

The guidelines also recommend antifungal prophylaxis, for example with trimethoprim-sulfamethoxazole, for patients on chemo regimens that carry a risk of Pneumocystis jirovecii pneumonia above 3.5%.

Antiviral prophylaxis with a nucleoside analog is recommended for herpes simplex virus (HSV)-positive patients receiving HSCT or induction therapy for leukemia. Patients who are at "substantial risk" of a reactivated hepatitis B virus (HBV) infection should receive prophylaxis with a nucleoside reverse transcription inhibitor, according to the guidelines.

Anyone treated with chemotherapy for a malignancy, along with their family and household contacts, should receive the influenza vaccine, according to the guidelines, which also include recommendations for other vaccines for immunosuppressed cancer patients.

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J Clin Oncol 2018.

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