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Antimicrobial Prophylaxis for Adult Patients with Cancer-Related Immunosuppression

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Antimicrobial Prophylaxis Table 1. Factors to Consider in Assessing Risk of a Febrile Neutropenic Episode in Patients Undergoing Cytotoxic Chemotherapy for Malignancy Factors Related to: Factor Effect on Risk Patient characteristics Advanced age Risk increases if ≥65 years Performance status Risk increases if ECOG ≥2 Nutritional status Risk increases if albumin <35 g/L Prior FN episode Risk in cycles 2–6 is 4-fold greater if FN episode occurs in cycle 1 Comorbidities FN odds increase by 27%, 67%, and 125%, respectively, for 1, 2 or ≥3 comorbidities Underlying malignancy Cancer diagnosis Diagnosis acute leukemia/MDS high-grade lymphoma so tissue sarcoma NHL/myeloma germ cell carcinoma Hodgkin lymphoma ovarian carcinoma lung cancers colorectal cancers head & neck carcinoma breast cancer prostate cancer Reported FN rates 85% to 95% 35% to 71% 27% (95% CI: 19–34.5%) 26% (95% CI: 22–29%) 23% (95% CI: 16.6–29%) 15% (95% CI: 6.6–24%) 12% (95% CI: 6.6–17.7%) 10% (95% CI: 9.8–10.7%) 5.5% (95% CI: 5.1–5.8%) 4.6% (95% CI: 1.0–8.2%) 4.4% (95% CI: 4.1–4.7%) 1% (95% CI: 0.9–1.1%) Cancer stage Risk increases for advanced stage (≥2) Remission status Risk increases if not in remission Cancer treatment response • Risk is lowest if patient has a CR • If patient has a PR, FN risk is greater for acute leukemia than for solid tissue malignancies • FN risk is higher if persistent, refractory, or progressive disease despite treatment

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