Febrile Neutropenia
Define FN
must have both fever and neutropenia 1. Fever15,16
a. Single temperature of at least 38.3°C (101°F) orally or a temperature of at least 38°C (100.4°F) orally for 1 hour
2. Neutropenia15,16
Less than 500 neutrophils/mcL or
Less than 1,000 neutrophils/mcL and anticipated decline to less
than or equal to 500 neutrophils/mcL or less in the upcoming 48 hours
What class of medications is granisetron?
5HT3 antagonist
What are the hallmark lab findings associated with TLS?
i. Hyperkalemia
ii. Hyperuricemia
iii. Hyperphosphatemia
iv. Hypocalcemia
What is the first line therapy for a fit AML patient?
7+3
A chemotherapy agent known to cause body fluid discoloration
Doxorubicin
What factors affect the severity of neutropenia?
Prior chemotherapy or radiation
Recent surgery or open wounds
Bilirubin greater than 2 g/dL
Creatinine clearance (CrCl) less than 50 mL/min
Age greater than 65 years if patient is receiving full-dose
chemotherapy
Bone marrow involvement
Baseline WBC count (preexisting leukopenia, neutropenia)
Define refractory CINV
Nausea that occurs despite taking optimal prevention measures
What type of IV fluids can we use in TLS? what is your urine output goal?
non alkalinized (give examples)
Urine output goal 80–100 mL/m2/h
What is the first line therapy for DLBCL?
RCHOP
A chemotherapy known to cause hypotension
Etoposide
What is the difference between neutropenia, severe neutropenia and profound neutropenia?
Neutropenia: ANC <1000
Severe neutropenia: ANC <500
Profound neutropenia: ANC <100
How many days of prophylactic CINV therapy are needed with HEC?
4 days in total
What is the first line medication therapy for the treatment of hypercalcemia and what is the dose?
Zoledronic acid 4 mg
Genetic mutations associated with poor prognosis of DLBCL?
MYC (chromosome 8), BCL2, BCL6
Double hit/triple hit lymphoma
A chemotherapy agent that is lethal if given intrathecally
Vincristine
Which antibiotic should be initiated empirically in patients presenting with FN?
Cefepime
Where is the site of action of 5HT3 antagonists and NK1 inhibitors?
5HT3: target gut serotonin receptors
NK1: target CNS
Explain in details the criteria used for the evaluation of lab TLS?
Cairo-bishop criteria
DLBCL chemo regimen that is adjusted based on patient's platelet and neutrophil level
DA-EPOCH
A chemotherapy agent known to cause neurotoxicity and conjunctivitis
Cytarabine
Name the most common bacteria and source of infection associated with FN
Pseudomonas - GI source
Which type of nausea does NK-1 inhibitors act on?
Prevention of acute and delayed nausea
Name agents used for prevention vs treatment for TLS including doses
Prevention: allopurinol 300 mg/m2
Treatment: rasburicase 6 mg flat dose
ADC targeting CD79b protein on malignant B cells
A chemotherapy agent known to cause mucositis
Melphalan