Tumor Lysis Syndrome

Leukostasis

Antimicrobial Prophylaxis

• Antibiotic prophylaxis with a fluoroquinolone is recommended for patients who are at high risk for FN or profound, protracted neutropenia (eg, most patients with acute myeloid leukemia/myelodysplastic syndromes (AML/MDS) or hematopoietic stem-cell transplantation (HSCT) treated with myeloablative conditioning regimens).
• Antifungal prophylaxis with an oral triazole or parenteral echinocandin is recommended for patients who are at risk for profound, protracted neutropenia, such as most patients with AML/MDS or HSCT.
• Prophylaxis is recommended, eg, trimethoprim-sulfamethoxazole (TMP-SMX), for patients receiving chemotherapy regimens associated with . 3.5% risk for pneumonia from Pneumocystis jirovecii (eg, those with ≥20 mg prednisone equivalents daily for ≥1 month or those on the basis of purine analogs).
• Herpes simplex virus–seropositive patients undergoing allogeneic HSCT or leukemia induction therapy should receive prophylaxis with a nucleoside analog (eg, acyclovir).

Neutropenic Fever

• Neutropenia is defined as an absolute neutrophil count <1000/μL, severe neutropenia as absolute neutrophil count <500/μL, and profound neutropenia as <100/μL.
• Fever in neutropenic patients is defined as a single oral temperature of ≥38.3°C (101°F) or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period.