How should I manage a patient with ALL who presents with complications such as febrile neutropenia?

Management of a patient with acute lymphoblastic leukaemia presenting with febrile neutropenia:

• Immediate referral and assessment: Suspect neutropenic sepsis in patients undergoing anticancer treatment who become unwell and refer immediately for assessment in secondary or tertiary care as this is a medical emergency ¹.
• Initial clinical assessment: Conduct a thorough history and examination, and perform investigations including full blood count, kidney and liver function tests, C-reactive protein, lactate, and blood cultures ¹.
• Empiric antibiotic therapy: Start empiric intravenous antibiotic therapy immediately, preferably beta-lactam monotherapy with piperacillin with tazobactam unless contraindicated ¹. Avoid aminoglycosides or glycopeptides initially unless specific indications exist ¹.
• Risk assessment: Assess the patient’s risk of septic complications within 24 hours using a validated risk scoring system by a healthcare professional competent in managing anticancer treatment complications ¹.
• Ongoing management: For high-risk patients, daily clinical review and reassessment of septic risk is required; do not switch empiric antibiotics unless clinical deterioration or microbiological indication occurs ¹.
• Antibiotic duration and discharge: Continue inpatient empiric antibiotics if fever persists without alternative cause; discontinue antibiotics once neutropenic sepsis responds irrespective of neutrophil count. Switch to oral antibiotics and consider discharge only after reassessment confirms low risk and social circumstances are appropriate ¹.
• Supportive care and facilities: Patients with acute lymphoblastic leukaemia at risk of prolonged neutropenia should be managed in facilities with appropriate isolation, rapid access to blood products, and emergency imaging ².
• Prevention: Consider prophylactic fluoroquinolone (ciprofloxacin) during expected neutropenia periods in adults, monitoring for resistance and side effects ¹.