We welcome the comments by Joshi1 and appreciate his interest in our work. Joshi comments that most of the difficulties in treating neutropenic febrile episodes are encountered when profound granulocytopenia (neutrophil count 100/L) persists for the duration of antimicrobial therapy, and that only in this setting, and in particular when a bacteremia caused by a Gram-negative agent is involved, should comparative efficacy between two different empiric antibiotic regimens be determined. As in the majority of published randomized trials that have supported the role of antibiotic monotherapy toward a synergistic combination in febrile neutropenia,2-4 in our study5 the response rate of the subgroup of patients with persistent profound neutropeniafor the duration of antibiotic therapywas not considered themajor end point. However, according to the InfectiousDiseases Society ofAmerica,6 the National Comprehensive Cancer Network,7 and the European Conference on Infections in Leukemia guidelines,8 the population enrolled in our study should be classified at the highest risk for infection, and in need of the prompt institution of intravenous broad-spectrum empiric antibiotic therapy. In fact, in our study, 85% of patients were profoundly neutropenic (neutrophil count 100/L) at the onset of fever, the median duration of profound neutropenia was 9 days, and the mean duration of chemotherapy induced neutropenia was 20 days. Moreover, the majority of the patients were affected by acute leukemia. The role of the duration of neutropenia as a prognostic factor for response to antibacterial treatment is controversial. In the recently published fourth European Conference on Infections in Leukemia “European Guideline for Empirical Therapy for Febrile Neutropenic Patients in the Era of Growing Resistance,”8 profound and persistent aplasia was included among the risk factors for a complicated clinical course. On the other hand, the duration of neutropenia is not considered an important risk factor by the Multinational Association for SupSupportive Care in Cancer Risk Index9 that considered underlying disease (such as acute leukemia) as a risk factor. Moreover, in our study5 the multivariable analysis did not confirm the duration of neutropenia as a predictive factor that could influence the failure of empiric therapy, and the same results were found in our previous prospective randomized trial that compared piperacillin/tazobactam with or without amikacin in the empiric treatment of febrile neutropenia.4 Conversely, the underlying disease (acute leukemia) represented an independent risk factor for failure in both studies.
Reply to J.H. Joshi / Micozzi, Alessandra; Gentile, Giuseppe; Bucaneve, Giampaolo. - In: JOURNAL OF CLINICAL ONCOLOGY. - ISSN 0732-183X. - STAMPA. - 32:34(2014), pp. 3899-3900. [10.1200/JCO.2014.57.9243]
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|Titolo:||Reply to J.H. Joshi|
|Data di pubblicazione:||2014|
|Citazione:||Reply to J.H. Joshi / Micozzi, Alessandra; Gentile, Giuseppe; Bucaneve, Giampaolo. - In: JOURNAL OF CLINICAL ONCOLOGY. - ISSN 0732-183X. - STAMPA. - 32:34(2014), pp. 3899-3900. [10.1200/JCO.2014.57.9243]|
|Appartiene alla tipologia:||01b Commento, Erratum, Replica e simili|