Current PerspectiveThe First European Conference on Infections in Leukaemia – ECIL1: A current perspective
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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Cited by (32)
8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation
2021, The Lancet OncologyCitation Excerpt :The 8th ECIL (ECIL-8) reconvened a Paediatric Group to review the current state of knowledge and to formulate updated recommendations for this population. The objective of the ECIL is to develop evidence-based guidelines for the management of infectious complications in immunocompromised patients after HCT, with leukaemia, or with other malignancies as previously described.6,7 Because a substantial amount of time has elapsed since the completion of the first paediatric-specific guideline in 2011, the group was reconvened in Jan 16, 2019, for an update.
Differences in characteristics between first and breakthrough neutropenic fever after chemotherapy in patients with hematologic disease
2016, International Journal of Infectious DiseasesCitation Excerpt :They also address breakthrough fever during broad-spectrum antibiotic therapy and prolonged neutropenia. However, the basic epidemiological data on which most guidelines are based do not distinguish between first fever and breakthrough fever.3–6 Only a few surveys have focused on differences in epidemiological profiles between first and breakthrough neutropenic fever episodes.1,2,7,8
Fourth European Conference on Infections in Leukaemia (ECIL-4): Guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation
2014, The Lancet OncologyCitation Excerpt :The ECIL is a joint initiative of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation, the Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC), the International Immunocompromised Host Society, and the European Leukaemia Net. The objective of ECIL is to develop evidence-based guidelines for management of infectious complications in immunocompromised patients with leukaemia, HSCT, and other malignancies, as applicable.10,11 The proceedings of the ECIL conferences have been previously described.10,11
Infection in Neutropenic Patients with Cancer
2013, Critical Care ClinicsComparison of characteristics of bacterial bloodstream infection between adult patients with allogeneic and autologous hematopoietic stem cell transplantation
2013, Biology of Blood and Marrow TransplantationCitation Excerpt :In previous studies, among recipients of allo-HSCT, HSCT from a matched unrelated donor (MUD) compared with HSCT from matched sibling donor (MSD) [1,6], human leukocyte antigen (HLA) matching [4,7], combined acute graft-versus-host disease (GVHD) [5-7], and pretransplantation elevation of inflammatory markers, such as serum C-reactive protein (CRP) and ferritin [8], have also been proposed as factors causing BSI. Although auto-HSCT and allo-HSCT are fundamentally different procedures, current guidelines [9-12] propose uniform recommendations regarding bacterial infection, including BSI, regardless of the type of HSCT. In a survey of pharmacists from 31 transplantation centers (30 from the United States and 1 from Mexico) taken during the 2003 Tandem BMT meeting in Keystone, Colorado, all centers reported using a similar approach to bacterial prophylaxis for auto-HSCT and allo-HSCT [13].
Characteristics of initial compared with subsequent bacterial infections among hospitalised haemato-oncological patients
2012, International Journal of Antimicrobial Agents