Evidence Based Practice Clinical Guideline Review

Guidelines for the Management of Fever and Neutropenia in Children with Cancer and Hematopoietic Stem Cell Transplantation Recipients: 2017 Update

Author(s): Thomas Lehrnbecher, Paula Robinson, Brian Fisher, Sarah Alexander, Roland A. Ammann, Melissa Beauchemin, Fabianne Carlesse, Andreas H. Groll, Gabrielle M. Haeusler, Maria Santolaya, William J. Steinbach, Elio Castagnola, Bonnie L. Davis, L. Lee Dupuis, Aditya H. Gaur,Wim J.E. Tissing, Theo Zaoutis, Robert Phillips, and Lillian Sung


Method of Review: A subcommittee of the Evidence Based Practice and Research Committee of the Association of Pediatric Hematology/Oncology Nurses conducted a group review of the clinical recommendations using the AGREE II criteria1. The committee had an overall assessment of approval for endorsement.

Review Summary: This is an update of the 2012 clinical practice guidelines which provide clinicians with recommendations for the risk stratification, evaluation, and treatment of fever and neutropenia in children with cancer and recipients of hematopoietic cell transplantation. The systematic review was very well done, and the recommendations are quite clear. A multi-disciplinary team of experts in pediatric oncology, infectious disease, a nurse, a pharmacist, and a patient advocate were involved in the entire process. For this update only pediatric randomized control trials were considered when evaluating the therapy issues. The substantial changes from 2012 were in the recommendations for empirical antifungal therapy. Many of the recommendations were graded as weak due to the lack of research in this area. The development group is clear that decisions about the implementation of the recommendations will need to be made at the institutional level. Future work on these guidelines will need to focus on closing the research gaps and identifying ways to facilitate implementation and adaptation.

Recommendation for use: Recommended for use in pediatric oncology.


1AGREE Next Steps Consortium (2009). The AGREE II Instrument [Electronic version]. Retrieved May, 2018, from www.agreetrust.org