Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia

M. L. Sulis, T. M. Blonquist, K. E. Stevenson, S. K. Hunt, S. Kay-Green, U. H. Athale, L. A. Clavell, P. D. Cole, K. M. Kelly, C. Laverdiere, J. M. Leclerc, B. Michon, M. A. Schorin, J. G. Welch, D. S. Neuberg, S. E. Sallan, L. B. Silverman

Research output: Contribution to journalArticle

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Abstract

Background: Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. Methods: Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. Results: Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different. Conclusion: For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.

Original languageEnglish (US)
JournalPediatric Blood and Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Induction Chemotherapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bacteremia
Fluoroquinolones
Anti-Bacterial Agents
Mycoses
Fever
Guidelines
Antibiotic Prophylaxis
Incidence
Vincristine
Prednisone
Infection
Methotrexate
Doxorubicin
Pediatrics

Keywords

  • Acute lymphoblastic leukemia
  • Children
  • Fluoroquinolone
  • Induction
  • Prophylaxis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Sulis, M. L., Blonquist, T. M., Stevenson, K. E., Hunt, S. K., Kay-Green, S., Athale, U. H., ... Silverman, L. B. (Accepted/In press). Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. Pediatric Blood and Cancer. https://doi.org/10.1002/pbc.26952

Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. / Sulis, M. L.; Blonquist, T. M.; Stevenson, K. E.; Hunt, S. K.; Kay-Green, S.; Athale, U. H.; Clavell, L. A.; Cole, P. D.; Kelly, K. M.; Laverdiere, C.; Leclerc, J. M.; Michon, B.; Schorin, M. A.; Welch, J. G.; Neuberg, D. S.; Sallan, S. E.; Silverman, L. B.

In: Pediatric Blood and Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Sulis, ML, Blonquist, TM, Stevenson, KE, Hunt, SK, Kay-Green, S, Athale, UH, Clavell, LA, Cole, PD, Kelly, KM, Laverdiere, C, Leclerc, JM, Michon, B, Schorin, MA, Welch, JG, Neuberg, DS, Sallan, SE & Silverman, LB 2018, 'Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia', Pediatric Blood and Cancer. https://doi.org/10.1002/pbc.26952
Sulis, M. L. ; Blonquist, T. M. ; Stevenson, K. E. ; Hunt, S. K. ; Kay-Green, S. ; Athale, U. H. ; Clavell, L. A. ; Cole, P. D. ; Kelly, K. M. ; Laverdiere, C. ; Leclerc, J. M. ; Michon, B. ; Schorin, M. A. ; Welch, J. G. ; Neuberg, D. S. ; Sallan, S. E. ; Silverman, L. B. / Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. In: Pediatric Blood and Cancer. 2018.
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abstract = "Background: Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. Methods: Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. Results: Sixty-six (28.7{\%}) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4{\%}) patients on prophylaxis developed fever and seven (10.6{\%}) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3{\%} vs. 26.3{\%}, P < 0.0001) due to a decreased rate of bacteremia (10.9{\%} vs. 24.4{\%}, P < 0.0001). The rate of fungal infections (4.8{\%} vs. 3.6{\%}) and induction death (0.9{\%} vs. 2{\%}) was not significantly different. Conclusion: For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.",
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T1 - Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia

AU - Sulis, M. L.

AU - Blonquist, T. M.

AU - Stevenson, K. E.

AU - Hunt, S. K.

AU - Kay-Green, S.

AU - Athale, U. H.

AU - Clavell, L. A.

AU - Cole, P. D.

AU - Kelly, K. M.

AU - Laverdiere, C.

AU - Leclerc, J. M.

AU - Michon, B.

AU - Schorin, M. A.

AU - Welch, J. G.

AU - Neuberg, D. S.

AU - Sallan, S. E.

AU - Silverman, L. B.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. Methods: Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. Results: Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different. Conclusion: For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.

AB - Background: Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. Methods: Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. Results: Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different. Conclusion: For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.

KW - Acute lymphoblastic leukemia

KW - Children

KW - Fluoroquinolone

KW - Induction

KW - Prophylaxis

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