Elsevier

European Journal of Cancer

Volume 44, Issue 15, October 2008, Pages 2112-2117
European Journal of Cancer

Current Perspective
The First European Conference on Infections in Leukaemia – ECIL1: A current perspective

https://doi.org/10.1016/j.ejca.2008.07.008Get rights and content

Abstract

The First European Conference on Infections in Leukaemia – ECIL1 – was organised under the auspices of the Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC), the Infectious Diseases Working Party of the European Group for Blood and Bone Marrow Transplantation (EBMT), the Supportive Care Group of the European LeukaemiaNet (ELN) and the International Immunocompromised Host Society (ICHS). The objective of the meeting was to develop evidence-based guidelines for the management of bacterial and fungal infections in high-risk immunocompromised adult leukaemia patients and hematopoietic stem cell transplantation recipients. The conference was held on September 30th and October 1st, 2005 in Juan-les-Pins, France and brought together a panel of 59 expert haematologists, oncologists, microbiologists, infectious disease specialists and clinical trialists from across Europe, Israel and Australia. The ECIL1 Guidelines were formulated after lengthy discussion, debate and panel consensus on the findings from a relevant comprehensive literature search, results of a European current practice questionnaire and other international guidelines, specific to each of the six clinical areas examined. The final recommendations, published in the Supplements of this journal as a series of six manuscripts in 2007, were well received by the medical community. The ECIL1 organisers anticipated the need for regular review of these guidelines and the Second ECIL Conference was held in September 2007. Publication of the updated and expanded ECIL2 Guidelines is forthcoming. This paper provides a concise summary of the methodology and main recommendations of the ECIL1 Guidelines.

Introduction

Guidelines from the First European Conference on Infections in Leukaemia – ECIL1 – for the management of bacterial and fungal infections in high-risk immunocompromised adult leukaemia and hematopoietic stem cell transplantation patients were published one year ago.1 This collaborative endeavour represents the work of the Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC), the Infectious Diseases Working Party of the European Group for Blood and Bone Marrow Transplantation (EBMT), the Supportive Care Group of the European LeukaemiaNet (ELN) and the International Immunocompromised Host Society (ICHS). These guidelines were developed in adherence to strict methodology by an independent network of international experts. Publication of the updated and expanded ECIL2 guidelines is forthcoming and certain to be equally well received by the medical community.2 This review provides a concise summary of the main ECIL1 recommendations which should aid clinicians, less involved in clinical research, in their daily practice.

Section snippets

Methodology of the ECIL1

The ECIL1 Organising Committee selected six important therapeutic topics for discussion by conference participants. These addressed bacterial and fungal infections in high-risk immunocompromised adult patients: (1) fluoroquinolone prophylaxis for the prevention of bacterial infections, (2) the need for aminoglycosides as part of an initial empirical antibiotic regimen, (3) the need for anti-Gram-positive antibiotics for the treatment of suspected Gram-positive infections, (4) antifungal

Quinolone prophylaxis in neutropenia4

Fluoroquinolones were assessed for the prevention of bacterial infection in acute leukaemia and hematopoietic stem cell transplantation (HSCT) patients and afebrile neutropenia. An evidence-based literature search identified 780 articles and abstracts with 19 relevant randomised controlled trials and 4 meta-analyses. The final analysis concentrated on two recent large randomised double-blind placebo-controlled trials (n = 2325) and one meta-analysis of the remaining 17 trials (n = 1409). End-points

Empirical antifungal therapy in neutropenia10

Empirical antifungal therapy in acute leukaemia and HSCT patients with neutropenia and persistent fever was assessed. An evidence-based literature search identified 25 comparative trials. Two studies compared empirical Amphotericin B (AmB) deoxycholate to no therapy and 23 trials compared various empirical regimens, 14 of which were excluded for investigating patients with invasive fungal infections at baseline, evaluating toxicity as the primary end-point or being underpowered. Planned

Future perspectives

The past 20 years have witnessed tremendous progress in the management of cancer-related infections. Numerous questions remain. Despite dramatic decreases in mortality, optimal prevention and treatment strategies must be re-evaluated in light of changes in treatment of the underlying diseases, use of oral agents, ambulatory treatment practices and the costs of newly developed drugs. These issues will be addressed within the ECIL framework with continued participation of the EORTC network to

Conflict of interest statement

None declared.

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