BJH - volume 15, issue 8, december 2024
Y. Vanbiervliet MD, R. Aerts MD, K. Lagrou MD, PhD, PharmD, A. Verlinden MD, PhD, J. Maertens MD, PhD, A. Schauwvlieghe MD, PhD
Background: Febrile neutropenia (FN) is an important complication in high-risk haematological patients, occurring in 80–90% of cases. While rapid initiation of broad-spectrum antibiotics has improved FN-related mortality, the optimal duration of treatment remains controversial. Prolonged use of antibiotics not only leads to resistance and toxicity but also to increased mortality and GVHD in allogeneic stem cell transplantation recipients due to disruption of the microbiome. Different guidelines provide different recommendations, leading to inconsistent practice and the ECIL guidelines are not widely implemented.
Methods: A national survey was conducted in Belgium to assess current practices for the management of FN in high-risk haematological patients. The electronic survey, consisting of 40 questions, was distributed to haematology centres via the newsletter of the Belgian Society of Haematology in January 2023. Responses from seventeen large haematology centres, including university hospitals, were analysed.
Results: Prophylactic measures such as germ-free diets and fluoroquinolone use were common, with 13/17 centres implementing germ-free diets and 11/17 centres using fluoroquinolone prophylaxis. Empirical broad-spectrum antibiotic treatment (EBAT) was initiated as monotherapy in 15/17 centres, predominantly with piperacillin-tazobactam (8/17) or third-/fourth-generation cephalosporins (7/17). Escalation to broader-spectrum antibiotics was common when FN persisted, with 9/17 centres using this approach. De-escalation practices varied, with 12/17 centres de-escalating if the patient showed improvement despite a severe initial presentation. Withdrawal of EBAT before neutrophil recovery occurred in 15/17 centres in stable, afebrile patients.
Discussion: The survey revealed partial compliance with the ECIL guidelines, with variations in escalation and de-escalation practices. While most centres followed recommended empirical treatments, de-escalation and early cessation remain difficult. The findings highlight the need for further research to optimise antibiotic use, reduce associated risks and reduce healthcare costs.
Conclusions: Although Belgian centres show better adherence to ECIL guidelines compared to other regions, challenges remain in de-escalation and early cessation of EBAT. A multicentre randomised controlled trial is needed to establish the safety of shorter EBAT durations and to improve antimicrobial stewardship.
(BELG J HEMATOL 2024;15(8):307–12)
Read moreBJH - volume 14, issue 2, march 2023
I. Moors MD, D. Deeren MD, C. Jacquy MD, PhD, A. Jaspers MD, PhD, T. Kerre MD, PhD, V. Havelange MD, PhD, D. Selleslag MD, C. Spilleboudt MD, N. Straetmans MD, PhD, F. Van Obbergh MD, A. De Voeght MD, S. Anguille MD, PhD, A. Schauwvlieghe MD, PhD, N. De Beule MD, PhD, A. De Becker MD, D. Breems MD, PhD
Acute myeloid leukaemia is an aggressive form of bone marrow cancer with poor prognosis, especially in elderly, unfit patients. The VIALE-A study showed an impressive improvement in complete remission rate and overall survival with the addition of venetoclax, a BCL-2 inhibitor, to azacitidine. This combination therapy is now reimbursed in Belgium for newly diagnosed adult AML patients who are considered unfit for intensive chemotherapy based on age and/or comorbidities. In this article, we provide recommendations on the use of this new combination, as well as on prophylaxis and management of specific side effects.
(BELG J HEMATOL 2023;14(2):59–66)
Read moreBJH - volume 12, issue 8, december 2021
A. Schauwvlieghe MD, PhD
An invasive fungal disease (IFD) is a life-threatening infection that is almost exclusively diagnosed in immunocompromised hosts. The most common invasive mould infection is caused by Aspergillus species and called invasive aspergillosis (IA). Patients with acute myeloid leukaemia who are treated with intensive chemotherapy and hematopoietic stem cell transplant recipients are at highest risk for IA. Incidence rates of IA vary substantially and depend on host and environmental factors but also the modalities of allogeneic stem cell transplantation recipients as well as the use of antifungal prophylaxis. Without prophylaxis the incidence of IA in these populations can be as high as 10–20%.1–3 IA does not only lead to a higher overall mortality and morbidity but also to substantially higher medical costs.4 The case fatality rate of IA is estimated to lie between 20–38%, six to twelve weeks after diagnosis but this as well varies substantially between populations.5 Therefore, optimising the management of IA is key in order to reduce the burden of this devastating complication in the immunocompromised host. For more than fifteen years voriconazole, a drug of the triazole class, has been the recommended treatment for this life-threatening infection after a pivotal randomised trial showed an improved survival with voriconazole compared with amphotericin B deoxycholate. However, also with voriconazole and improved diagnostic tests, the overall 6-week mortality is still unacceptably high at 25–30%.6 A troublesome emerging problem in patients with IA is the increasing incidence of infections with triazole-resistant A. fumigatus. Although limited by numbers, case series have demonstrated that the overall mortality of patients infected with triazole-resistant A. fumigatus is very high (50–88%).7,8 This thesis focuses on risk factors for and the diagnosis of invasive aspergillosis. Additionally, the management of azole-resistant aspergillosis is addressed. The thesis consisted of several chapters. You can read all chapters in the digital version of the thesis. We briefly summarise the most important findings in every chapter.
(BELG J HEMATOL 2021;12(8):353–4)
Read more
Top
