Supportive Care in Hematology

  • John Hiemenz
  • Reinhold Munker
Part of the Contemporary Hematology book series (CH)


Patients with hematological malignancies such as leukemias and lymphomas are predisposed to a wide spectrum of infections that need special attention. These patients are immunosuppressed not only as a result of the immune defects associated with the underlying disease, but also because of the treatment regimens that generally further decrease the patient’s resistance to infections. An intensive transfusion support with platelets, red cell concentrates, immunoglobulins, cytokines, and other drugs is necessary. Many patients also need antiemetic agents, nutritional support, pain medication, and, very often, venous catheters. All of these measures are considered supportive care and apply in a similar fashion to the high-dose treatment of solid tumors. Supportive care measures, along with the treatment and prophylaxis of infections, are discussed in this chapter. Transfusion support is discussed in Chapter 22.


Central Venous Catheter Clin Infect Antifungal Therapy Invasive Aspergillosis Invasive Fungal Infection 
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  1. 1.
    Bodey GP, Buckley M, Sathe YS, et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328–340.PubMedGoogle Scholar
  2. 2.
    Pizzo PA. Fever in immunocompromised patients. N Engl J Med 1999; 341:893–900.PubMedCrossRefGoogle Scholar
  3. 3.
    Donowitz GR, Maki DG, Crnich CJ, Pappas PG, Roloston KV. Infections in the neutropenic patient—new views of an old problem. Hematology 2001;113–139.Google Scholar
  4. 4.
    Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730–751.PubMedCrossRefGoogle Scholar
  5. 5.
    de Pauw BE, Donnelly JP. Infections in the immunocompromised host: general principles. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practices of Infectious Diseases, 5th ed. Philadelphia: Churchill Livingston, 2000:pp. 3079–3090.Google Scholar
  6. 6.
    Bodey GP. Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents 2000; 16:93–95.PubMedCrossRefGoogle Scholar
  7. 7.
    DesJardin JA, Falagas ME, Ruthazer R, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med 1999; 131:641–647.PubMedGoogle Scholar
  8. 8.
    Caillot D, Couaillier J-F, Bernard A, et al. Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia. J Clin Oncol 2001; 19:253–259.PubMedGoogle Scholar
  9. 9.
    Pazos C, Ponton J, Del Palacio A. Contribution of (1–3) beta-D-glucan chromogenic assay to diagnosis and monitoring of invasive aspergillosis in neutropenic adult patients. J Clin Microbiol 2005; 43:299–305.PubMedCrossRefGoogle Scholar
  10. 10.
    Pinel C, Fricker-Hidalgo H, Lebeau B, et al. Detection of circulating Aspergillus fumigatus galactomannan value and limits of the Platelia test for diagnosing invasive aspergillosis. J Clin Microbiol 2003; 41:2184–2186.PubMedCrossRefGoogle Scholar
  11. 11.
    Walsh TJ, Shoham S, Petraitiene R, et al. Detection of galactomannan antigenemia in patients receiving piperacillin-tazobactam and correlations between in vitro, in vivo, and clinical properties of the drug-antigen interaction. J Clin Microbiol 2004; 42:4744–4748.PubMedCrossRefGoogle Scholar
  12. 12.
    Rolston KVI. Stenotrophomonas maltophilia infection in cancer patients-frequency, spectrum of infection and antimicrobial susceptibility. European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2003;Glasgow, Scotland Abs. 678Google Scholar
  13. 13.
    Safdar N, Maki DO. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aerues, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834–844.PubMedGoogle Scholar
  14. 14.
    Razonable RR, Litzow MR, Kaliq Y, et al. Bacteremia due to viridans group streptococci with diminished susceptibility to levofloxacin among neutropenic patients receiving levofloxacin prophylaxis. Clin Infect Dis 2002; 34:1469–1474.PubMedCrossRefGoogle Scholar
  15. 15.
    Jantunen E, Ruutu P, Niskanen L, et al. Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients. Bone Marrow Transplant 1997; 19:801–808PubMedCrossRefGoogle Scholar
  16. 16.
    Yuen KY, Woo PCY, Ip MSM, et al. Stage-specific manifestations of mold infections in bone marrow transplant recipients: risk factors and clinical significance of positive concentrated smears. Clin Infect Dis 1997; 25:37–42.PubMedGoogle Scholar
  17. 17.
    Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003; 102:827–833.PubMedCrossRefGoogle Scholar
  18. 18.
    Keating MJ, Flinn I, Jain V, et al. Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood 2002; 99:3554–3561.PubMedCrossRefGoogle Scholar
  19. 19.
    McNeil MM, Nash SL, Hajjeh RA, et al. Trends in mortality due to invasive mycotic diseases in the United States. 1980/2-1997. Clin Infect Dis 2001; 33:641–647.PubMedCrossRefGoogle Scholar
  20. 20.
    Walsh TJ, Groll A, Hiemenz J, et al. Infections due to emerging and uncommon fungal pathogens. Clin Microbiol Infect 2004; 10:48–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Ison MG, Hayden FG, Kaiser L, et al. Rhino virus infections in hematopoietic stem cell transplant recipients with pneumonia. Clin Infect Dis 2003;36:1139–1143.PubMedCrossRefGoogle Scholar
  22. 22.
    Martino R, Ramila E, Rabella N, et al. Respiratory virus infections in adults with hematologic malignancies: a prospective study. Clin Infect Dis 2003;26:1–8.CrossRefGoogle Scholar
  23. 23.
    Marcolini JA, Malik S, Suki D, et al. Respiratory disease due to parainfluenza virus in adult leukemia patients. Eur J Clin Microbiol Infect Dis 2003;22:79–84.PubMedGoogle Scholar
  24. 24.
    Freifeld A, Marchigiani D, Walsh T, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low risk febrile patients with neutropenia during cancer chemotherapy. N Eng J Med 1999;341:305–311.CrossRefGoogle Scholar
  25. 25.
    Rolston KVI. New trends in patient management: risk-based therapy for febrile patients with neutropenia. Clin Infect Dis 1999;29:515–521.PubMedGoogle Scholar
  26. 26.
    Del Favero A, Menichetti F, Marino P, et al. A multicenter, double-blind, placebocontrolled trial comparing piperacillin-tazobactam with and without amikacin as empiric therapy for febrile neutropenia. Clin Infect Dis 2001;33:1295–1301.PubMedCrossRefGoogle Scholar
  27. 27.
    Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996; 10:365–400.PubMedCrossRefGoogle Scholar
  28. 28.
    Pizzo PA, Robichaud KJ, Gill FA, et al. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982;72:101–111.PubMedCrossRefGoogle Scholar
  29. 29.
    EORTC International Antimicrobial Therapy Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med 1989;86:668–672.CrossRefGoogle Scholar
  30. 30.
    White MH, Bowden RA, Sandler ES, et al. Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 1998;27:296–302.PubMedGoogle Scholar
  31. 31.
    Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 1999; 340:764–771.PubMedCrossRefGoogle Scholar
  32. 32.
    Boogaerts M, Winston DJ, Bow EJ, et al. Intravenous and oral itraconazole versus intravenous amphotericin B deoxycholate as empirical antifungal therapy for persistent fever in neutropenic patients with cancer who are receiving broad-spectrum antibacterial therapy; a randomized controlled trial. Ann Intern Med 2001;135:412–422.PubMedGoogle Scholar
  33. 33.
    Walsh TJ, Pappas P, Winston DJ, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med 2002;346:225–234.PubMedCrossRefGoogle Scholar
  34. 34.
    Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 2004;351(14):1391–1402.PubMedCrossRefGoogle Scholar
  35. 35.
    National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report. Data summary from January 1990-May 1999. Am J Infect Control 1999;27:520–532.CrossRefGoogle Scholar
  36. 36.
    National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillence (NNIS) System report. Data summary from January 1992–April 2000. Am J Infect Control 2000;28:429–448.CrossRefGoogle Scholar
  37. 37.
    Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis 2002;34:1524–1529.PubMedCrossRefGoogle Scholar
  38. 38.
    Donskey CJ, Chowdhry TK, Hecker MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.PubMedCrossRefGoogle Scholar
  39. 39.
    Edmond M, Ober JF, Weinbaum DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.PubMedGoogle Scholar
  40. 40.
    Patterson DL, Rice LB. Empirical antibiotic choice for the seriously ill patient; are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? Clin Infect Dis 2003; 36:1006–1012.CrossRefGoogle Scholar
  41. 41.
    National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report. Data summary from January 1992–June 2001. Am J Infect Control 2001;29:404–421.CrossRefGoogle Scholar
  42. 42.
    Stevens DL, Dotter B, Madaras-Kelly K. A review of linezolid: the first oxazolidinone antibiotic. Expert Rev Anti Infect Ther 2004;2:51–59.PubMedCrossRefGoogle Scholar
  43. 43.
    Raad I, Hachem R, Hanna H, et al. Prospective randomized study comparing quinupristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections. J Antimicrob Chemother 2004;53:646–649.PubMedCrossRefGoogle Scholar
  44. 44.
    Rao N, Ziran BH, Wagener MM, et al. Similar hematologic effects of long-term linezolid and vancomycin in a prospective observational study of patients with orthopedic infections. Clin Infect Dis 2004;38:1058–1064.PubMedCrossRefGoogle Scholar
  45. 45.
    Meissner HC, Townsend T, Wenman W, et al. Hematologic effects of linezolid in young children. Pediatr Infect Dis J 2003;22(S19):186–192.Google Scholar
  46. 46.
    Dibo I, Pillai SK, Gold HS, et al. Linezolid-resistant Enterococcus faecalis isolated from a cord blood transplant recipient. J Clin Microbiol 2004;42:1843–1845.PubMedCrossRefGoogle Scholar
  47. 47.
    Pappas PG, Rex JH, Sobel JD, et al. Guidelines for the treatment of candidiasis. Clin Infect Dis 2004;38:161–189.PubMedCrossRefGoogle Scholar
  48. 48.
    Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996;10:365–400.PubMedCrossRefGoogle Scholar
  49. 49.
    Nucci M, Anaissie E. Should vascular catheters be removed from allpatients with candidemia? An evidence-based review. Clin Infect Dis 2002;34:591–599.PubMedCrossRefGoogle Scholar
  50. 50.
    Walsh TJ, Rex JH. All catheter-related candidemia is not the same: assessment of the balance between the risks and benefits of removal of vascular catheters. Clin Infect Dis 2002;34:600–602.PubMedCrossRefGoogle Scholar
  51. 51.
    Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002;347:2020–2029.PubMedCrossRefGoogle Scholar
  52. 52.
    Gerson SL, Talbot GH, Hurwitz S, et al. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med 1984;100:345–351.PubMedGoogle Scholar
  53. 53.
    Patterson TF, Kirkpatrick WR, White M, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. Medicine (Baltimore) 2000;79:250–60.CrossRefGoogle Scholar
  54. 54.
    Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis 2000;30:696–709.PubMedCrossRefGoogle Scholar
  55. 55.
    Hiemenz JW, Walsh TJ. Lipid formulations of amphotericin B: Recent progress and future directions. Clin Infect Dis 1996;22(S2): pp133-144.Google Scholar
  56. 56.
    Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408–415.PubMedCrossRefGoogle Scholar
  57. 57.
    Caillot D, Mannone L, Cuisenier B, et al. Role of early diagnosis and agressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients. Clin Microbiol Infect 2001;7(S2):54–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Bartizal K, Gill CJ, Abruzzo GK, et al. In vitro preclinical evaluation studies with the echinocandin antifungal MK-0991 (L-743,872). Antimicrob Agents Chemother 1997;41:2326–2332.PubMedGoogle Scholar
  59. 59.
    Arikan S, Lozano-Chiu M, Paetznick V, et al. In vitro synergy of caspofungin and amphotericin B against Aspergillus and Fusarium spp. Antimicrob Agents Chemother 2002;46:245–247.PubMedCrossRefGoogle Scholar
  60. 60.
    Perea S, Gonzalez G, Fothergill AW, et al. In vitro interaction of caspofungin acetate with voriconazole against clinical isolates of Aspergillus spp. Antimicrob Agents Chemother 2002;46:3039–3041.PubMedCrossRefGoogle Scholar
  61. 61.
    Kirkpatrick WR, Perea S, Coco B J, et al. Efficacy of caspofungin alone and in combination with voriconazole in a guinea pig model of invasive aspergillosis. Antimicrob Agents Chemother 2002;46:2564–25PubMedCrossRefGoogle Scholar
  62. 62.
    Petraitis V, Petraitiene R, Sarafandi AA, et al. Combination therapy in treatment of experimental pulmonary aspergillosis: synergistic interaction between an antifungal triazole and an echinocandin. J Infect Dis 2003;187:1834–1843.PubMedCrossRefGoogle Scholar
  63. 63.
    Aliff TB, Maslak PG, Jurcic JG, et al. Refractory aspergillus pneumonia in patients with acute leukemia. Successful therapy with combination caspofungin and liposomal amphotericin. Cancer 2003; 97:1025–1032.PubMedCrossRefGoogle Scholar
  64. 64.
    Kontoyiannis DP, Hachem R, Lewis RE, et al. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematological malignancies. Cancer 2003; 98:292–299.PubMedCrossRefGoogle Scholar
  65. 65.
    Marr KA, Boeckh M, Carter RA, et al. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004;39:797–802.PubMedCrossRefGoogle Scholar
  66. 66.
    Sherertz RJ, Belani A, Kramer BS, et al. Impact of air filtration on nosocomial aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987; 83:7109–7718.Google Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • John Hiemenz
    • 1
  • Reinhold Munker
    • 1
  1. 1.Louisiana State UniversityShreveportUSA

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