Neutropenic Fever Module Appendices

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1 Neutropenic Fever Module Appendices Examples of Chemotherapy Regimens with Medium to High Risk of Febrile Neutropenia... 2 Examples of Chemotherapy Regimens with a High Risk of Febrile Neutropenia (> 20%)... 2 Examples of Chemotherapy Regimens with an Intermediate Risk of Febrile Neutropenia (10-20%)... 3 Colony Stimulating Factors Used to Accelerate Neutrophil Recovery Time... 5 Performance Evaluation Scales... 6 ECOG/ Zubrod... 6 Karnofsky scoring... 6 Lansky score... 7 Additional Recommendations for Antimicrobial Prophylaxis in Severely Immunocompromised Patients... 8 Nomenclature for Neutrophils... 8 Reference List... 9 Suggested Reading Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 1 of 11

2 Examples of Chemotherapy Regimens with Medium to High Risk of Febrile Neutropenia This list is not comprehensive, there are other agents/regimens that have a high risk for the development of febrile neutropenia The type of chemotherapy regimen is only one component of the Risk Assessment The exact risk includes agent, dose, and the treatment setting (i.e., treatment naive versus heavily pretreated patients Pegfilgrastim has not been documented to have benefit in regimens given under 2 week duration. Examples of Chemotherapy Regimens with a High Risk of Febrile Neutropenia (> 20%) Bladder Cancer o MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) (neoadjuvant, adjuvant, metastatic Breast Cancer o Docetaxel + trastuzumab (metastatic or relapsed) o Dose dense AC T* (doxorubicin, cyclophosphamide, paclitaxel) (adjuvant) o AT (doxorubicin, paclitaxel) (metastatic or relapsed) o AT (doxorubicin, docetaxel) (metastatic or relapsed) o TAC (docetaxel, doxorubicin, cyclophosphamide) (adjuvant Esophageal and Gastric Cancer o Docetaxel/cisplatin/fluorouracil Non-Hodgkin's Lymphoma o ICE (ifosfamide, carboplatin, etoposide) (Diffuse Large B-Cell, Lymphoma, Peripheral T cell Lymphomas, 2nd line, salvage) o RICE* (rituximab, ifosfamide, carboplatin, etoposide) o CHOP-14* (cyclophosphamide, doxorubicin, vincristine, prednisone) o MINE (mesna, ifosfamide, novantrone and etoposide) (Diffuse Large B-Cell Lymphoma, Peripheral T cell Lymphomas, 2nd line, refractory) o DHAP (dexamethasone, cisplatin, cytarabine) (Peripheral T cell Lymphomas, Diffuse Large B-Cell Lymphoma, 2nd line) o ESHAP (etoposide, methylprednisolone, cisplatin, cytarabine) (Diffuse Large B-Cell Lymphoma, Peripheral T cell Lymphoma, 2nd line, recurrent) o BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) o HyperCVAD + R (cyclophosphamide, vincristine, doxorubicin, dexamethasone + rituxan ) (Burkitt's Lymphoma) Melanoma o Dacarbazine-based combination (dacarbazine, cisplatin, vinblastine) (advanced, metastatic, or recurrent) o Dacarbazine-based combination with IL-2, interferon alfa (dacarbazine, cisplatin, vinblastine, IL-2, interferon alfa) (advanced, metastatic, or recurrent) Myelodysplastic syndrome o Decitabine Ovarian Cancer o Topotecan o Paclitaxel o Docetaxel Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 2 of 11

3 Pancreatic Cancer o Gemcitabine/ docetaxel Sarcoma o MAID (mesna, doxorubicin, ifosfamide, dacarbazine) o Doxorubicin Small Cell Lung Cancer o Topotecan Testicular Cancer o VeIP (vinblastine, ifosfamide, cisplatin) o VIP (etoposide, ifosfamide, cisplatin) o BEP (bleomycin, etoposide, cisplatin) o TIP (paclitaxel, ifosfamide, cisplatin) ** In general, dose dense regimens require growth factor support for chemotherapy National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Myeloid Growth Factors [v1.2009] TM National Comprehensive Cancer Network, Inc. Available at: Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v1.2009] National Comprehensive Cancer Network, Inc. Available at: Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to Examples of Chemotherapy Regimens with an Intermediate Risk of Febrile Neutropenia (10-20%) Occult Primary-Adenocarcinoma o Gemcitabine, docetaxel Breast Cancer o Docetaxel every 21 days o Epirubicin (adjuvant) o Epirubicin + sequential cyclophosphamide + methotrexate + 5-fluorouracil (adjuvant) o CMF classic (cyclophosphamide, methotrexate, fluorouracil) (adjuvant) o AC +(doxorubicin, cyclophosphamide) sequential docetaxel (adjuvant) (taxane portion only) o AC + sequential docetaxel + trastuzumab (adjuvant) o FEC (fluorouracil, epirubicin, cyclophosphamide) + sequential docetaxel o Paclitaxel every 21 days (metastatic or relapsed) o Vinblastine (metastatic or relapsed) Cervical Cancer o Cisplatin + topotecan (recurrent or T metastatic) o Topotecan (recurrent or metastatic) o Irinotecan (recurrent or metastatic) Colon Cancer o FOLFOX (fluorouracil, leucovorin, oxaliplatin) Esophageal Cancer Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 3 of 11

4 o o o Irinotecan/Cisplatin Epirubicin/cisplatin/5-fluorouracil Epirubicin/cisplatin/Capecitabine Hodgkin's Lymphoma o ABVD (doxorubicin, bleomycin, vinblastine dacarbazine) o Stanford V (mechlorethamine, doxorubicin, vinblastine, bleomycin, etoposide, prednisone) Non-Hodgkin's Lymphoma o EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) (AIDS-related NHL, Burkitt's lymphoma, recurrent) o EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) + IT chemotherapy (AIDSrelated NHL, Diffuse Large B-Cell Lymphoma, recurrent) o Rituximab + HyperCVAD alternating with Methotrexate + Cytarabine (CVAD template) (cyclophosphamide, vincristine, doxorubicin, dexamethasone) regimen included IT methotrexate o ACOD (modified CHOP-doxorubicin, cyclophosphamide, vincristine, prednisone) o GDP (gemcitabine, dexamethasone, cisplatin) (Peripheral T-cell Lymphomas, Diffuse Large B-Cell Lymphoma, 2nd line) o GDP (gemcitabine, dexamethasone, cisplatin) + Rituximab (Diffuse Large B-Cell Lymphoma, 2nd line) o FM (fludarabine, mitoxantrone) o CHOP + R (cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab) Non-Small Cell Lung Cancer o Cisplatin/paclitaxel (adjuvant, advanced/ metastatic) o Cisplatin/vinorelbine (adjuvant, advanced/metastatic) o Cisplatin/docetaxel (adjuvant, advanced/ metastatic) o Cisplatin/irinotecan (advanced/metastatic) o Cisplatin/etoposide (adjuvant, advanced/ metastatic) o Carboplatin/paclitaxel (adjuvant, advanced /metastatic) o Docetaxel (advanced/metastatic) Ovarian Cancer o Carboplatin/docetaxel Small Cell Lung Cancer o Etoposide/carboplatin Testicular Cancer o Etoposide/cisplatin Uterine Cancer o Docetaxel (uterine sarcoma, advanced or metastatic) National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Myeloid Growth Factors [v1.2009] TM National Comprehensive Cancer Network, Inc. Available at: Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v1.2009] National Comprehensive Cancer Network, Inc. Available at: Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 4 of 11

5 Colony Stimulating Factors Used to Accelerate Neutrophil Recovery Time Drug/ Indication Dose/ Schedule/Duration Side Effects Neupogen (Filgrastim) G-CSF rhu G-CSF Reduce febrile neutropenia in patients receiving myelosuppressive chemotherapy; reduce duration of neutropenia after bone marrow transplantation, mobilize progenitor cells for stem cell transplantation 5 mcg/kg/day (rounding to the nearest vial size by institutiondefined weight limits) Vials are available in 300 mcg and 480 mcg dosage units. Subcutaneous route preferred Starting hours after chemotherapy completed Administered daily for up to 2 weeks until clinical evidence of adequate neutrophil recovery Should be discontinued if ANC surpasses 10,000 /mm 3 Not to be administered in the 24 hr period before administration of next chemotherapy Most common side effect is mild-to-moderate bone pain (>10%) Splenomegaly reported in chronic use Transient dyspnea and pulmonary infiltrates on CXR Monitor WBC during therapy to prevent leukocytosis Rare, serious adverse events include: allergic-type reactions (particularly with the first dose) Skin: rash, urticaria, facial edema Respiratory: wheezing, dyspnea Cardiovascular: hypotension, tachycardia splenic rupture in persons undergoing peripheral blood stem cell mobilization (including healthy donors), adult respiratory distress syndrome in neutropenic patients with infection Precipitate sickle cell disease crisis Neulasta Pegfilgrastim is indicated to decrease incidence of infection, evidenced by NF in non-myeloid malignancies receiving chemo associated with clinically significant incidence NF Leukine (Sargramostime) GM-CSF is not FDA approved for prophylaxis of febrile neutropenia in nonmyeloid malignancies Approved only for neutrophil recovery following chemo for acute myeloid leukemia (AML) Fixed dose of 6 mg once per chemo cycle Not to be administered in the period 14 days before and 24 hours after administration of chemo The elimination of pegfilgrastim is self-regulated by neutrophil receptor mediated clearance. 250 mcg/m2 per day (rounding to the nearest vial size by institution-defined weight limits) Vials are 250 mcg and 500 mcg dosages. Subcutaneous route preferred Started on D11 or 4 days following the completion of AML induction chemo Continue until ANC is >1500/mm3 for 3 consecutive days or maximum of 42 days Side effects are same as Neupogen (above) If a patient experiences hyperleukocytosis (white blood cell counts > 100K/mm3 ) a dose reduction would be indicated since drug is only available in a set 6-mg dose, a dose reduction of this agent is not practical instead a nonpegylated GCSF should be considered for subsequent cycles Typical side effects include: injection site reactions, low-grade fever, and myalgias Occasionally dyspnea, (due to sequestration of granulocytes in pulmonary vasculature) bone pain (like GSCF) Rare adverse events: allergic-type reactions with the first dose and fluid retention High doses induce weight gain, pericarditis, pleuritis and a capillary leak syndrome, pleural and/or pericardial effusion Elevation of serum creatinine or bilirubin and hepatic enzymes. Monitor closely in pts w/ elevated renal or liver functions prior to initiation of tx Cardiovascular symptoms: Occasional transient supraventricular arrhythmia. Monitor patients with preexisting cardiac disease Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 5 of 11

6 Performance Evaluation Scales Evaluating a patient s Performance Status is an effort to quantify their ability to do activities of daily living. This measurement is thought to not only reflect the patient s functional status and but also general well being. The two most commonly used adult performance status scales are the Zubrod and the Karnofsky. Since the Zubrod is used by the Eastern Cooperative Oncology Group in their publications, it is also known as the ECOG. The World Health Organization (WHO) uses a modification of this scale. The significance of evaluating performance status is that it is used to determine if a patient s selection for a clinical trial or if they are a candidate for certain treatments. Patients with poor performance status may be excluded from certain treatments or may require dose modification if their anticipated poor tolerance of the treatment and subsequent morbidity/ mortality may outweigh the benefit. A more observational tool is used with children, since they may be unable to articulate their ADLs or quality of life. The Lansky scoring system has been validated for use in children by Lansky, et al, in ECOG/ Zubrod 0 Asymptomatic Fully active, able to carry on all predisease activities without restriction 1 Symptomatic but completely ambulatory Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. i.e., light housework, office work 2 Symptomatic, <50% in bed during the day ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours 3 Symptomatic, >50% in bed, but not bedbound capable of only limited self-care, confined to bed or chair 50% or more of waking hours 4 Bedbound completely disabled; cannot carry on any self-care. Totally confined to bed or chair 5 Death Eastern Cooperative Oncology Group (ECOG); World Health Organization (WHO) Oken MM, et al (1982) Am. J. Clin. Oncol. 5 (6): Karnofsky scoring 100% normal, no complaints, no signs of disease 90% capable of normal activity, few symptoms or signs of disease 80% normal activity with some difficulty, some symptoms or signs 70% caring for self, not capable of normal activity or work 60% requiring some help, can take care of most personal requirements 50% requires help often, requires frequent medical care 40% disabled, requires special care and help 30% severely disabled, hospital admission indicated but no risk of death Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 6 of 11

7 20% very ill, urgently requiring admission, requires supportive measures or treatment 10% moribund, rapidly progressive fatal disease processes 0% death Karnofsky DA, Burchenal JH. (1949). "The Clinical Evaluation of Chemotherapeutic Agents in Cancer." In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ Press. p196. Zubrod compared with Karnofsky A comparison between the Zubrod and Karnofsky scales has been validated in a large sample of patients: Zubrod 0 equals Karnofsky 100; Zubrod 1 equals Karnofsky 80-90; Zubrod 2 equals Karnofsky 60-70; Zubrod 3 equals Karnofsky 40-50; Zubrod 4 equals Karnofsky 20-30;10-20 Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer Jun; 32A (7): Lansky score 100% fully active, normal 90% strenuous physical activity with minor restrictions 80% active, but tired more quickly 70% greater restriction of play and less time spent in play activity 60% up and around, but active play minimal; keeps busy by being involved in quieter activities 50% lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities 40% mainly in bed; participates in quiet activities 30% bedbound; needing assistance even for quiet play 20% sleeping often; play entirely limited to very passive activities 10% doesn't get out of bed and doesn t play 0% unresponsive Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR (1987). "The measurement of performance in childhood cancer patients". Cancer 60 (7): Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 7 of 11

8 Additional Recommendations for Antimicrobial Prophylaxis in Severely Immunocompromised Patients Pneumococcal prophylaxis with Penicillin Pts w/ splenectomy or are functionally asplenic Allogeneic HSCT pts Pts w/ chronic Graft versus Host disease Cytomegalovirus (CMV) prophylaxis for high risk pts Allo HSCT 1 to 6 months after transplant GVHD CD4 < 100 cells/mcl Pts tx with alemtuzumab (Campath ) For a minimum of 2 mo after alemtuzumab and until CD4 >100 cells/mcl Pneumocystis jiroveci prophylaxis previously known as Pneumocystis carinii pneumonia (PCP) Allo HSCT and pts tx with alemtuzumab (Campath ) Acute Leuks throughout antileukemic therapy Pts on T-cell depleting agents (Fludarabine, Cladribine) Pts on prolonged steroids (20 mg/day prednisone >4wks) Pts receiving concurrent temozolomide +RT Hepatitis B prophylaxis Immunocompromised pts with positive hepatitis B surface antigen Penicillin prophylaxis x5 yrs after splenectomy or at least 1 yrs after allo HSCT and until immunosuppressive tx discontinued in cgvhd pts TMP- SMZ (Bactrim DS) can also be used Ganciclovir OR Foscarnet OR Valganciclovir Trimethoprim-sulfamethoxazole (TMP- SMZ) for at risk pts If TMP-SMZ intolerant or allergic consider desensitization, OR atovaquone, dapsone, or aerosolized pentamidine when PCP prophylaxis is required Lamivudine The NCCN Clinical Practice Guidelines in Oncology Prevention and Treatment of Cancer- related Infections (VERSION ) 2009 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed [July, 2009]. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org Nomenclature for Neutrophils Neutrophils are also known as polymorphonuclear leukocytes, or informally as polys, PMNs, PMLs Reflects the muti shaped nucleus Also called granulocyte or granular leukocyte Reflects the granules in the cytoplasm of the neutrophil Also known as segmented neutrophils or informally segs Slightly immature form of circulating neutrophil known as banded neutrophil or informally bands Normally, most of the neutrophils circulating in the bloodstream are in a mature form, with the nucleus of the cell being divided or segmented. Because of the segmented appearance of the nucleus, neutrophils are sometimes referred to as segmented neutrophils or "segs." The slightly immature form of a neutrophils (which is released from bm into peripheral blood in response to infection) has a nucleus that is not completely segmented rather more of a band or rod- like shape and thus is known as a band or stab (stab is a German term for rod) Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 8 of 11

9 Reference List Bonadonna, G., Moliterni, A., Zambetti, M., Daidone, M.G., Pilotti, S., Gianni, L., et al. (2005). 30 years follow up of randomised studies of adjuvant CMF in operable breast cancer: Cohort study [Epub]. BMJ, 330, 217. Boyce, J.M., Pittet, D., & Healthcare Infection Control Practices Advisory Committee. Society for Healthcare Epidemiology of America. Association for Professionals in Infection Control. Infectious Diseases Society of America. Hand Hygiene Task Force. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infection Control and Hospital Epidemiology, 23(12 Suppl), S3 S40. Caggiano, V., Weiss, R.V., Rickert, T., Linde-Zwirble, W.T. (2005). Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer, 103 (9), Cella, D., Chang, C.H., Lai, J.S., & Webster, K. (2002). Advances in quality of life measurements in oncology patients. Seminars in Oncology, 29 (3, Suppl. 8), Chernecky, C. C. (2008) Laboratory tests and diagnostic procedures (5 th ed) St. Louis. Saunders Elsevier. Clarkson, J.E., Worthington, H.V., & Eden, O.B. (2003). Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Reviews, 3, CD Common Terminology Criteria for Adverse Events (Version 3.0) by the National Cancer Institute Cancer Therapy Evaluation Program, Retrieved April 10, 2009 from Epelbaum, R., Haim, N., Ben-Shahar, M., Ron, Y., & Cohen, Y. (1988). Dose intensity for CHOP chemotherapy in diffuse aggressive large cell lymphoma. Israel Journal of Medical Sciences, 24, Fortner, B.V., Tauer, K., Zhu, L., Okon, T.A., Moore, K., Templeton, D., et al. (2004). Medical visits for chemotherapy and chemotherapy-induced neutropenia: A survey of the impact on patient time and activities. BMC Cancer, 4, 22. Gardner, A. (2007). Should Prophylactic Antibiotics Be Given to Neutropenic Patients? Neutropenia Special Interest Group Newsletter 5(3), 1. Gea-Banacloche, J. C. et al (2008) Infections in the Cancer Patient. In DeVita, V. T. Lawrence T.S. Rosenberg, S. A. (Eds.), DeVita, Hellman, and Rosenberg s Cancer: Principles & Practice of Oncology (8 th ed., p2580) Philadelphia. Wolters Kluwer Health/Lippincott Williams & Wilkins. Kwak, L.W., Halpern, J., Olshen, R.A., & Horning, S.J. (1990). Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: Results of a tree-structured survival analysis. Journal of Clinical Oncology, 8, Larson, E., & Nirenberg, A. (2004). Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer. Oncology Nursing Forum, 31, Lyman, G.H., & Kuderer, N.M. (2002). Filgrastim in patients with neutropenia: Potential effects on quality of life. Drugs, 62(Suppl. 1), Marrs, J.A., (2006). Care of Patients With Care of Patients With Neutropenia. Clinical Journal of Oncology Nursing 10(2), National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Myeloid Growth Factors [v1.2009] TM National Comprehensive Cancer Network, Inc. Available at: Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 9 of 11

10 Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to National Comprehensive Cancer Network. (2009). The NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v1.2009] National Comprehensive Cancer Network, Inc. Available at: Accessed April To view the most recent and complete version of the NCCN Guidelines, go online to Payne, S., Jarrett, N., & Jeffs, D. (2000). The impact of travel on cancer patients experiences of treatment: A literature review. European Journal of Cancer Care (England), 9, Picozzi, V.J., Pohlman, B.L., Morrison, V.A., Lawless, G.D., Lee, M.W., Kerr, R.O., et al. (2001). Patterns of chemotherapy administration in patients with intermediate-grade non-hodgkin s lymphoma. Oncology, 15, Ropka, M.E. Padilla, G. (2007). Assessment of Neutropenia-Related Quality of Life in a Clinical Setting. Oncology Nursing Forum, 34 (2), Rubenstein, E.B., Peterson, D.E., Schubert, M., Keefe, D., McGuire, D., Epstein, J., et al. (2004). Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer, 100(9, Suppl.), Sehulster, L., & Chinn, R.Y. (2003). Guidelines for environmental infection control in health-care facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Morbidity and Mortality Weekly Report. Recommendations and Reports, 52(RR-10), Shelton, B.K. (2003). Evidence-based care for the neutropenic patient with leukemia. Seminars in Oncology Nursing, 19, Smith, C.M., & Kagan, S.H. (2005). Prevention of systemic mycoses by reducing exposure to fungal pathogens in hospitalized and ambulatory neutropenic patients. Oncology Nursing Forum, 32, Smith TJ, Khatcheressian J, Lyman G, et al update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline. J Clin Oncol 2006; 24: Wilson, B.J. (2002). Dietary recommendations for neutropenic patients. Seminars in Oncology Nursing, 18, Zitella, L., Friese, C., Gobel, B. H., Woolery, M., O Leary, C., Hauser, J., Andrews, F. (2006). ONS PEP Card. Putting Evidence Into Practice: Prevention of Infection. Zitella, L. J., Friese, C. R., Hauser, J., Gobel, B. H., Woolery, M., O Leary, C., Andrews, F.A. (2006). Putting Evidence Into Practice: Prevention of Infection. Clinical Journal of Oncology Nursing, 10(6), Suggested Reading Althaus, B., (2007) Myeloid Growth Factor Therapy for Prophylaxis of Febrile Neutropenia in Non-Myeloid Malignancies: Appropriate Doses and Schedules. Journal of the National Comprehensive Cancer Network. 5(2) Marrs, J.A., (2006). Care of Patients With Care of Patients With Neutropenia. Clinical Journal of Oncology Nursing 10(2), Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 10 of 11

11 Newton, S., Hickey, M., & Marrs, J. (2009). Complete Blood count Test (CBC). In Mosby s Oncology Nursing Advisor: A Comprehensive guide to Clinical Practice. (pp ) St. Louis, MI: Mosby Elsevier. Newton, S., Hickey, M., & Marrs, J. (2009). Neutropenia. In Mosby s Oncology Nursing Advisor: A Comprehensive guide to Clinical Practice. (p. 497) St. Louis, MI: Mosby Elsevier. Newton, S., Hickey, M., & Marrs, J. (2009). Sepsis. In Mosby s Oncology Nursing Advisor: A Comprehensive guide to Clinical Practice. (pp ) St. Louis, MI: Mosby Elsevier. Gholz, R.C. (2009). Fever. In Newton, S., Hickey, M., & Marrs, J., Mosby s Oncology Nursing Advisor: A Comprehensive guide to Clinical Practice. (pp ) St. Louis, MI: Mosby Elsevier. Nirenberg, A., Bush, A. P., Davis, A., Friese, C. R., Gillespie, T. W., Rice, R. D. (2006). Oncology Nursing Society White Paper. Neutropenia: State of the Knowledge Part I. Oncology Nursing Forum. 33 (6) Nirenberg, A., Bush, A. P., Davis, A., Friese, C. R., Gillespie, T. W., Rice, R. D. (2006). Oncology Nursing Society White Paper. Neutropenia: State of the Knowledge Part II. Oncology Nursing Forum. 33 (6) Wilson, B. J., Gardner, A. E. (2007). Nurses' Guide to Understanding and Implementing the National Comprehensive Cancer Network Guidelines for Myeloid Growth Factors. Oncology Nursing Forum 34 (2) Zitella, L., Friese, C., Gobel, B. H., Woolery, M., O Leary, C., Hauser, J., Andrews, F. (2006). ONS PEP Card. Putting Evidence Into Practice: Prevention of Infection. Zitella, L. J., Friese, C. R., Hauser, J., Gobel, B. H., Woolery, M., O Leary, C., Andrews, F.A. (2006). Putting Evidence Into Practice: Prevention of Infection. Clinical Journal of Oncology Nursing, 10(6), Neutropenic Fever Module Copyright UT M. D. Anderson Cancer Center Page 11 of 11