Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

doi:10.1007/s00277-019-03622-0

Review

. 2019 May;98(5):1051-1069.

doi: 10.1007/s00277-019-03622-0. Epub 2019 Feb 22.

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

Matthias Kochanek^{1

2}, E Schalk^{3

4}, M von Bergwelt-Baildon^{3

5}, G Beutel^{3

6}, D Buchheidt^{3

7}, M Hentrich⁸, L Henze^{3

9}, M Kiehl^{3

10}, T Liebregts^{3

11}, M von Lilienfeld-Toal¹², A Classen¹³, S Mellinghoff¹³, O Penack¹⁴, C Piepel¹⁵, B Böll^{13

3}

Affiliations

¹ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Matthias.Kochanek@uk-koeln.de.
² Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany. Matthias.Kochanek@uk-koeln.de.
³ Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
⁴ Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
⁵ Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany.
⁶ Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany.
⁷ Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany.
⁸ Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany.
⁹ Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany.
¹⁰ Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany.
¹¹ Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹² Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.
¹³ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
¹⁴ Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁵ Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany.

PMID: 30796468
PMCID: PMC6469653
DOI: 10.1007/s00277-019-03622-0

Review

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

Matthias Kochanek et al. Ann Hematol. 2019 May.

. 2019 May;98(5):1051-1069.

doi: 10.1007/s00277-019-03622-0. Epub 2019 Feb 22.

Authors

Affiliations

¹ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Matthias.Kochanek@uk-koeln.de.
² Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany. Matthias.Kochanek@uk-koeln.de.
³ Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
⁴ Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
⁵ Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany.
⁶ Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany.
⁷ Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany.
⁸ Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany.
⁹ Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany.
¹⁰ Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany.
¹¹ Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹² Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.
¹³ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
¹⁴ Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁵ Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany.

PMID: 30796468
PMCID: PMC6469653
DOI: 10.1007/s00277-019-03622-0

Abstract

Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.

Keywords: Cancer; Guideline; Management; Neutropenia; Sepsis; Septic shock.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Sepsis definition for neutropenic patients analog to Sepsis-3 guidelines [12]. (ANC, absolute neutrophil count; FUO, fever of unknown origin; qSOFA, quick SOFA; SOFA, Sepsis-Related Organ Failure Assessment; GCS, Glasgow Coma Scale; SBP, systolic blood pressure; MAP, mean arterial pressure)

**Fig. 2**
Diagram for diagnosis of sepsis and septic shock. Important clinical symptoms are highlighted in bold. ANC, absolute neutrophil count; SBP, systolic blood pressure; MAP, mean arterial pressure; bpm, beats per minute; SD, standard deviation; CRP, C-reactive protein; PCT, procalcitonin

See this image and copyright information in PMC

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References

1. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013;31:2810–2818. - PubMed
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[1] Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013;31:2810–2818. - PubMed

[2] Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013;31:2810–2818. - PubMed

[3] Soares M, Bozza FA, Azevedo LCP, Silva UVA, Corrêa TD, Colombari F, Torelly AP, Varaschin P, Viana WN, Knibel MF, Damasceno M, Espinoza R, Ferez M, Silveira JG, Lobo SA, Moraes APP, Lima RA, de Carvalho AGR, do Brasil PEAA, Kahn JM, Angus DC, Salluh JIF. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol. 2016;34:3315–3324. - PubMed

[4] Soares M, Bozza FA, Azevedo LCP, Silva UVA, Corrêa TD, Colombari F, Torelly AP, Varaschin P, Viana WN, Knibel MF, Damasceno M, Espinoza R, Ferez M, Silveira JG, Lobo SA, Moraes APP, Lima RA, de Carvalho AGR, do Brasil PEAA, Kahn JM, Angus DC, Salluh JIF. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol. 2016;34:3315–3324. - PubMed

[5] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A (2017) Surviving Sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. 10.1007/s00134-017-4683-6 - PubMed

[6] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A (2017) Surviving Sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. 10.1007/s00134-017-4683-6 - PubMed

[7] Ullmann AJ, Akova M, Herbrecht R, Viscoli C, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Donnelly JP, Garbino J, Groll AH, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Roilides E, Verweij PE, Cuenca-Estrella M, ESCMID Fungal Infection Study Group ESCMID* guideline for the diagnosis and management of Candidadiseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT) Clin Microbiol Infect. 2012;18:53–67. - PubMed

[8] Ullmann AJ, Akova M, Herbrecht R, Viscoli C, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Donnelly JP, Garbino J, Groll AH, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Roilides E, Verweij PE, Cuenca-Estrella M, ESCMID Fungal Infection Study Group ESCMID* guideline for the diagnosis and management of Candidadiseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT) Clin Microbiol Infect. 2012;18:53–67. - PubMed

[9] Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiol. 2018;55:30–38. - PMC - PubMed

[10] Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiol. 2018;55:30–38. - PMC - PubMed

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Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

Affiliations

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

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