Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.


PURPOSE To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN). METHODS The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations. RESULTS Recommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented. CONCLUSION This guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.

DOI: 10.1200/JCO.2012.42.7161

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@article{Lehrnbecher2012GuidelineFT, title={Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.}, author={Thomas Lehrnbecher and Robert Phillips and Sarah Alexander and Frank Alvaro and Fabianne Carlesse and Brian Fisher and Hana Hakim and Maria Santolaya and Elio Castagnola and Bonnie L Davis and L Lee Dupuis and Faith Gibson and Andreas H Groll and Aditya Gaur and Ajay Gupta and Rejin Kebudi and S{\'e}rgio Petrilli and William J Steinbach and Milena Villarroel and Theoklis Zaoutis and Lillian Sung}, journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology}, year={2012}, volume={30 35}, pages={4427-38} }