ABSTRACT

Introduction

Febrile neutropenia represents one of the most common treatment-associated complications in the management of acute myeloid leukemia (AML) and is considered an oncologic emergency. Rapid and detailed workup as well as the initiation of empiric broad-spectrum antibiotic therapy are critical to avoid sepsis and to reduce mortality. Although a definitive source of infection is frequently not identified, the severely immunosuppressed status of the AML patient undergoing cytotoxic therapy results in a high risk for a wide array of bacterial, fungal, and viral etiologies.

Areas covered

The authors herein review the diagnostic and therapeutic approach to the neutropenic leukemia patient based on the current knowledge. Special consideration is given to the rapidly changing therapeutic landscape in AML, creating new challenges in the management of infectious complications.

Expert opinion

Multidrug-resistant organisms pose a major challenge in the management of neutropenic fever patients with hematologic malignancies – including AML. Future directions to improve outcomes demand innovative treatment approaches as well as advances in biomarker research to facilitate diagnosis and disease monitoring. Recent achievements in AML-targeted therapy led to an increased incidence of differentiation syndrome, a potentially life-threatening side effect that frequently resembles clinical infection and requires prompt recognition and aggressive intervention.

中文翻译：

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成人急性髓系白血病患者发热和中性粒细胞减少症的处理

摘要

介绍

发热性中性粒细胞减少症是急性髓系白血病 (AML) 治疗中最常见的治疗相关并发症之一，被认为是一种肿瘤急症。快速和详细的检查以及开始经验性广谱抗生素治疗对于避免败血症和降低死亡率至关重要。尽管通常无法确定明确的感染源，但接受细胞毒治疗的 AML 患者的严重免疫抑制状态导致多种细菌、真菌和病毒病因的高风险。

覆盖区域

本文作者根据现有知识回顾了对中性粒细胞减少性白血病患者的诊断和治疗方法。特别考虑了 AML 快速变化的治疗环境，这给感染并发症的管理带来了新的挑战。

专家意见

多重耐药菌对患有血液系统恶性肿瘤（包括 AML）的中性粒细胞减少性发热患者的管理构成了重大挑战。改善结果的未来方向需要创新的治疗方法以及生物标志物研究的进步，以促进诊断和疾病监测。AML 靶向治疗的最新成就导致分化综合征的发生率增加，这是一种可能危及生命的副作用，通常类似于临床感染，需要及时识别和积极干预。