Standards / SOP 's of Project 15: Supportive Care

Introduction

Antiviral Treatment

Antifungal Therapy

Antibacterial Treatment

Neutropenia

Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia
Bone Marrow Transplant. 2009 May;43(10):757-70. Epub 2008 Dec 1
These guidelines on the management of HSV, VZV and EBV infection in patients with hematological malignancies and after SCT were prepared by the European Conference on Infections in Leukemia following a predefined methodology. A PubMed search was conducted using the appropriate key words to identify studies pertinent to management of HSV, VZV and EBV infections. References of relevant articles and abstracts from recent hematology and SCT scientific meetings were also reviewed. Prospective and retrospective studies identified from the data sources were evaluated, and all data deemed relevant were included in this analysis. The clinical and scientific background was described and discussed, and the quality of evidence and level of recommendation were graded according to the Centers for Disease Control criteria.

Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT
Bone Marrow Transplant. 2008 Aug;42(4):227-40. Epub 2008 Jun 30
These recommendations were prepared by the European Conference on Infections in Leukaemia following a predefined methodology. Literature searches were made to identify studies pertinent to management of CMV, HHV-6, -7 and -8 infections. For CMV, 76 studies were reviewed: 72 published and 4 presented as abstracts. Twenty-nine of these studies were prospective randomized trials. For the other herpesviruses, HHV-6, -7 and -8, no randomized controlled trial has been performed, although data from some studies with other primary endpoints have been used to assess the management of HHV-6 infection. Works presented only as abstracts were used to a very limited extent. The quality of evidence and level of recommendation were graded according to the Center for Disease Control (CDC) criteria.

Quinolone prophylaxis for bacterial infections in afebrile high risk neutropenic patients
EJC Supplements 2007 (Vol. 5, 5-12)
These recommendations have been developed by an expert panel following an evidence-based search of the literature assessing the role of fluoroquinolones in the prevention of bacterial infection in patients with acute leukaemia or bone marrow transplantation and neutropenia. We present results from a questionnaire on the current practice among experts in Europe, show results of the literature search, review recommendations available from other international guidelines and provide the panel’s recommendations.

Empirical antifungal therapy in neutropaenic cancer patients with persistent fever
EJC Supplements 2007 (Vol. 5, 32-42)
Invasive fungal infections are frequent and severe complications in leukaemic patients with prolonged neutropaenia. Empirical antifungal therapy has become the standard of care in patients with persistent fever despite treatment with broad-spectrum antibiotics. For decades amphotericin B deoxycholate has been the sole option for empirical antifungal therapy. Recently, several new antifungal agents became available. The choice of the most appropriate drug should be guided by efficacy and safety criteria. The recommendations from the First European Conference on Infections in Leukaemia (ECIL-1) on empirical antifungal therapy in neutropaenic cancer patients with persistent fever have been developed by an expert panel after assessment of clinical practices in Europe and evidence-based review of the literature. Many antifungal regimens can now be recommended for empirical therapy in neutropaenic cancer patients. However, persistent fever lacks specificity for initiation of therapy. Development of empirical and pre-emptive strategies using new clinical parameters, laboratory markers and imaging techniques for early diagnosis of invasive mycoses are needed.

Primary antifungal prophylaxis in leukaemia patients
EJC Supplements 2007 (Vol. 5, 43-48)
These recommendations have been developed by an expert panel following an evidence-based search of the literature assessing the role of primary antifungal prophylaxis in patients with acute leukaemia or stem cell transplantation. We present results from a questionnaire on the current practice among experts in Europe, show results of the literature search and provide the panel’s recommendations.

Treatment of invasive Candida and invasive Aspergillus infections in adult haematological patients
EJC Supplements 2007 (vol.5, 49-59)
An increasing incidence of invasive fungal infections is observed in most immunocompromised patients, and especially leukaemia patients. In order to decrease the mortality due to these infections, the clinicians need to optimise their treatment choices for the most common fungal infections observed in this population: invasive aspergillosis and candidiasis. These recommendations have been developed by an expert panel following an evidence-based search of the literature assessing the role of antifungal therapies in the treatment of patients with acute leukaemia or bone marrow transplantation and invasive candidiasis – including candidaemia – and aspergillosis. We present results from a questionnaire on the current practice among experts in Europe, show results of the literature search and provide the panel’s recommendations.

Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT
Bone Marrow Transplant. 2005 Apr;35(8):737-46.
Over the last 25 years, the numbers of hematopoietic stem cell transplant (SCT) patients have increased rapidly. Infections have been major obstacles for successful transplantation. Thus, infection prevention is very important in transplant recipients. As the results of transplantation have improved, the number of long-term survivors has increased. Vaccination is a potentially important strategy for reducing the risk for vaccine-preventable infections after SCT. The EBMT produced recommendations for vaccination of SCT recipients published in Bone Marrow Transplantation in 1995. This paper updates the previous recommendations based on current knowledge.