Management of the febrile neutropenic cancer patient: lessons from 40 years of study

Authors

  • E. J. Bow

    1. Sections of Infectious Diseases and Haematology/Oncology, Department of Internal Medicine, The University of Manitoba and Department of Medical Oncology and Haematology, Infection Control Services, CancerCare Manitoba, Winnipeg, Manitoba, Canada
    Search for more papers by this author

Corresponding author and reprint requests: E. J. Bow, Health Sciences Centre, Rm GD600, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9
E-mail: ebow@hsc.mb.ca

Abstract

Almost forty years ago the relationship between the circulating neutrophil count and the risk of pyogenic infection was established. Since that time, through the vehicle of clinical trials, much has been learnt about the etiologies, risk factors, pathogenesis, and natural history of first and subsequent febrile neutropenic episodes. Refinements to the empirical antibacterial management has reduced infection-related mortality to less than 10 percent. Algorithmic approaches to persistent fever in the setting of severe neutropenia have been developed. Circumstances wherein preventative strategies are most efficacious have been defined. Clinicians have learned that neutropenic patients comprise a heterogeneous population that does not encounter the same risks for infection-related morbidity and mortality. Tailored stratified approaches to management of the febrile neutropenic patient have been developed that are safe and cost-effective.

Ancillary