Clinical Management of Febrile Neutropenia in Cancer Patients

Resumo

Febrile neutropenia (FN) is one of the most frequent and potentially life-threatening complications of cancer therapy, associated with significant morbidity, mortality, and healthcare costs. Appropriate management requires accurate risk stratification and therapeutic decisions guided by up-to-date evidence and antimicrobial stewardship principles. To synthesize current evidence on the clinical management of febrile neutropenia (FN) in oncology patients based exclusively on the provided abstracts. This narrative review analyzed seven articles, including clinical guidelines, review articles, and one phase 3 randomized controlled trial. Risk stratification is central to FN management. Updated pediatric guidelines conditionally recommend discontinuing empirical antibiotic therapy in low-risk patients who are clinically stable, afebrile, and have negative blood cultures at 48 hours, as well as implementing pre-emptive antifungal therapy in high-risk patients without mold-active prophylaxis. In adults with hematologic malignancies, antibiotic de-escalation represents a key management focus. A phase 3 trial in IDH1-mutated acute myeloid leukemia demonstrated that ivosidenib plus azacitidine improved survival and reduced the incidence of FN (28% vs. 34%). FN is associated with hospitalizations lasting up to 10 days and costs reaching up to $65,000 per pediatric admission. Prophylactic granulocyte colony-stimulating factor (G-CSF) reduces the incidence of FN. Multidrug-resistant organisms remain a major clinical challenge. The management of FN requires risk-adapted strategies that integrate rapid assessment, evidence-based guidelines, and antimicrobial stewardship.