Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO/IDSA 2018
- Design
- Joint ASCO and IDSA clinical practice guideline update based on a systematic review of studies (May 2011 to November 2016) and review of the evidence by an expert panel
- Sample size
- Six new or updated meta-analyses and six new primary studies were added to the systematic review
- Source
- JCO · 2018
In plain words
People with cancer whose immune system has been weakened by the illness or its treatment are more likely to get infections. This guideline says that in high-risk patients, the doctor may prescribe preventive medicines against bacteria, fungi or viruses. For some patients, prevention of a particular type of pneumonia, prevention of hepatitis B flaring up again, vaccination and avoiding high-risk environments are also recommended. Decisions about taking these medicines should always be made with your treating doctor.
Key points
Key guideline recommendations
- Level of evidence and strength of recommendation in the full guideline
Antibacterial and antifungal prophylaxis is recommended for patients at high risk of infection, including patients expected to have profound, prolonged neutropenia (fewer than 100 neutrophils per microlitre for more than 7 days) or other risk factors.
- Level of evidence and strength of recommendation in the full guideline
HSV-seropositive patients undergoing allogeneic haematopoietic stem cell transplantation or leukaemia induction therapy should receive nucleoside analogue antiviral prophylaxis, such as acyclovir.
- Level of evidence and strength of recommendation in the full guideline
Prophylaxis against Pneumocystis jirovecii is recommended for patients receiving chemotherapy regimens associated with a greater than 3.5% risk of pneumonia from this organism (e.g. ≥ 20 mg prednisone equivalent daily for ≥ 1 month, or based on purine analogue use).
- Level of evidence and strength of recommendation in the full guideline
Treatment with a nucleoside reverse transcriptase inhibitor (e.g. entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation.
- Level of evidence and strength of recommendation in the full guideline
Recommendations on vaccination and on avoiding prolonged exposure to environments with high concentrations of airborne fungal spores are also given in the guideline.
Study population
Adult patients with immunosuppression related to cancer and its treatment.
Endpoints
This document is a clinical practice guideline and has no trial endpoint. Its aim is to give recommendations on antimicrobial prophylaxis (antibacterial, antifungal and antiviral), prophylaxis against Pneumocystis jirovecii, prevention of hepatitis B virus reactivation, vaccination and avoidance of environments at high risk for fungal spores.
Safety and side effects
The abstract gives no information on adverse events or grade ≥ 3 events. See the full guideline for the safety considerations of each prophylactic agent.
Clinical significance and place in guidelines
This guideline provides a joint ASCO and IDSA framework for antimicrobial prophylaxis in adult patients with cancer-related immunosuppression. Given its definition of profound, prolonged neutropenia, its risk threshold for Pneumocystis jirovecii pneumonia and the groups needing HSV and HBV prophylaxis, it can be used in clinical decision-making. The current status of the guideline and any post-publication updates should be checked, and drug and dose selection should follow the full guideline and the patient's circumstances.
Limitations
The abstract does not report the level of evidence or strength of each recommendation, or details of drugs and doses. The systematic review extended to November 2016 and the recommendations are based on review of the evidence by an expert panel. Newer evidence should be checked separately.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.