NCCN Clinical Practice Guidelines in Oncology (NCCN ...

1 NCCN Guidelines IndexTable of ContentsDiscussionNCCN Guidelines Version and treatment of cancer - related InfectionsVersion , 05/02/2013 National Comprehensive cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . Clinical Practice Guidelines in Oncology (NCCN Guidelines ) prevention andTreatment ofCancer-RelatedInfectionsVersion Guidelines IndexTable of ContentsDiscussionNCCN Guidelines Version and treatment of cancer - related InfectionsVersion , 05/02/2013 National Comprehensive cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.

2 NCCN StaffMaoko Naganuma, MScDorothy A. Shead, MSContinueNCCN Guidelines Panel DisclosuresLindsey Robert Baden, MD Co-ChairDana-Farber/Brigham and Women'sCancer Center | Massachusetts GeneralHospital cancer CenterMichael Angarone, DORobert H. Lurie Comprehensive CancerCenter of Northwestern UniversityCorey Casper, MD, MPHFred Hutchinson cancer ResearchCenter/Seattle cancer Care AllianceErik R. Dubberke, MDSiteman cancer Center at Barnes-Jewish Hospital and WashingtonUniversity School of MedicineAlison G. Freifeld, MD UNMC Eppley cancer Center atThe Nebraska Medical CenterRamiro Garzon, MDThe Ohio State UniversityComprehensive cancer Center -James cancer Hospital and SoloveResearch InstituteFFFFW illiam Bensinger, MD Co-Chair Fred Hutchinson cancer ResearchCenter/Seattle cancer Care AllianceKieren A.

3 Marr, MDThe Sidney Kimmel ComprehensiveCancer Center at Johns HopkinsJose G. Montoya, MDStanford cancer InstituteAshley Morris-Engemann, PharmDDuke Comprehensive cancer CenterPeter G. Pappas, MDUniversity of Alabama at BirminghamComprehensive cancer CenterKen Rolston, MDThe University of Texas MD AndersonCancer CenterBrahm Segal, MDRoswell Park cancer InstituteSusan K. Seo, MD Memorial Sloan-Kettering cancer CenterSankar Swaminathan, MDHuntsman cancer Institute at theUniversity of UtahF FFFFX Infectious diseases Hematology/Hematology Oncology Internal medicinePulmonary medicine Medical oncologyPharmacology* Writing committee memberJohn N. Greene, MD Moffitt cancer CenterJohn P. Greer, MD Vanderbilt-Ingram cancer CenterJames I.

4 Ito, MDCity of Hope Comprehensive CancerCenterJudith E. Karp, MD The Sidney Kimmel ComprehensiveCancer Center at Johns HopkinsDaniel R. Kaul, MDUniversity of Michigan ComprehensiveCancer CenterEarl King, MDFox Chase cancer CenterEmily Mackler, PharmDUniversity of MichiganComprehensive cancer CenterFFFX Panel Members**Printed by Eliot Williams on 6/11/2014 11:19:20 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive cancer Network, Inc., All Rights Guidelines IndexTable of ContentsDiscussionNCCN Guidelines Version and treatment of cancer - related InfectionsVersion , 05/02/2013 National Comprehensive cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.

5 NCCN Guidelines Name Panel MembersSummary of the Guidelines UpdatesAntimicrobial Prophylaxis (INF-1)Antifungal Prophylaxis (INF-2)Antiviral Prophylaxis (INF-3) prevention of CytomegalovirusDisease (INF-4)Antipneumocystis Prophylaxis (INF-6)Initial Evaluation of Fever and Neutropenia (FEV-1)Site Specific Evaluation and Therapy:Mouth, Esophagus, and Sinus/nasal (FEV-6)Abdominal Pain, Perirectal Pain, Diarrhea,(FEV-7)Lung Infiltrates (FEV-8)Cellulitis,, Vesicular Lesions, Disseminated Papules or Other Lesions,Central Nervous System Symptoms (FEV-9)Principles of Daily Follow-Up (FEV-10)Follow-Up Therapy for Responding Patients (FEV-11)(CMV) Reactivation orPrevention of Hepatitis B Virus (HBV) Reactivation or Disease (INF-5)Initial Risk Assessment for Febrile Neutropenic Patients (FEV-2)Urinary Tract SymptomsVascular Access DevicesOutpatient Therapy for Low-Risk Patients (FEV-3)Initial Empiric Therapy For Uncomplicated Fever And Neutropenia (Without Localization) (FEV-5) Clinical Trials:Categories of Evidence andConsensus.

6 NCCNAll recommendationsare Category 2A unless that the best managementfor any cancer patient is in a clinicaltrial. Participation in Clinical trials isespecially find Clinical trials online at NCCN member institutions,click of Evidenceand ConsensusAntibacterial Agents Table (FEV-A)Antifungal Agents Table (FEV-B)Antiviral Agents Table (FEV-C)Risk Assessment Resources (FEV-D)Adjunctive Therapies (FEV-E)Appropriate Use of Vancomycin (FEV-F)Table of ContentsThe NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinicalcircumstances to determine any patient s care or treatment .

7 The National Comprehensive cancer Network (NCCN ) makes no representations orwarranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCNG uidelines are copyrighted by National Comprehensive cancer Network . All rights reserved. The NCCN Guidelines and the illustrations herein may notbe reproduced in any form without the express written permission of NCCN. 2013. Printed by Eliot Williams on 6/11/2014 11:19:20 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive cancer Network, Inc., All Rights Guidelines IndexTable of ContentsDiscussionNCCN Guidelines Version and treatment of cancer - related InfectionsVersion , 05/02/2013 National Comprehensive cancer Network, Inc.

8 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . Note: All recommendations are category 2A unless otherwise Trials: NCCN believes that the best management of any cancer patient is in a Clinical trial. Participation in Clinical trials is especially in the version of the prevention and treatment of cancer - related infections Guidelines from the version include:INF-3:INF-4:INF-5 INF-6 FEV-1 FEV-6 FEV-5 In the table under 2nd column (Disease/Therapy Examples), 4th row(for High), replaced bortezomib therapy with proteasomeinhibitors. After Pre-emptive therapy, re-ordered the listed drugs as: Ganciclovir (IV) or Valganciclovir (PO) or Cidofovir (IV) orFoscarnet (IV).

9 Under Disease / Therapy Samples, in the upper pathway for Allogeneic stem cell after Active HBV, modified 1stbullet Delay transplant to transplant. Under Disease / Therapy Samples, in the bottom pathway after Anti-CD20 monoclonal , added a column for Considerantiviral prophylaxis if HBsAg+ or HBcAb+. Under Antipneumocystis prophylaxis, after TMP/SMX, removed (preferred) and replaced with (category 1) ; also, changed thecontent that follows to: or Atovaquone, dapsone, pentamidine(if TMP/SMX intolerant. Footnote v , add a new sentence as the first sentence: The list ofagents is alphabetical and does not reflect preference. Under Clinical Presentation for Fever, modified the content to: bullet1 Single temperature equivalent C orally or bullet 2 Equivalent to38 C orally over 1-hr period.)

10 Consider delaying aerosolized or IV)In the 1st column, 3rd bullet, change the content to Potentialinfecting organisms include multi-drug resistant organisms(MDRO). Under Additions to Initial Empiric Regimen, for Sinus/nasalpathway, deleted the bullet for Infectious disease consult. FEV-7 FEV-9 FEV_A (1 of 4)FEV-B (page 1 of 4):FEV-C (page 1 of 4): Under Additions to Initial Empiric Regimen, for Diarrhea pathway,added or oral vancomycin after oral metronidazole. Under Evaluation, for CNS pathway, deleted the 1st bullet for Infectious disease consult. For linezolid, under Comments/Precautions, deleted the last bullet, Not recommended for line infections . For daptomycin, under Dose, changed to 6 mg/kg/d IV ; also, underComments/Precautions, deleted the 1st bullet Equivalent tostandard antistaphylococcal agents forbacteremis at 6 mg/kg dose in non-neutropenic patients.