Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis
We are grateful to Dr. Ching-Hon Pui of St. Jude Children's Research Hospital in Memphis, Tennessee, for his advice.
For patients with childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) who are receiving intensive chemotherapy, prophylaxis with antibiotic and antifungal agents can significantly reduce the rate of life-threatening infections in patients with ALL who are undergoing induction chemotherapy, bloodstream infections in patients with AML who are being treated with high-dose chemotherapy, and invasive fungal infections in patients with AML who are receiving modest-dose chemotherapy. Prophylaxis regimens also have been found to reduce the number of episodes of febrile neutropenia, the length of stay in the intensive care unit for patients with ALL, mortality caused by severe infections in patients with AML, and cost.
The purpose of the current study was to prevent bloodstream infection and invasive fungal infection (IFI) by administering prophylactic antibiotic and antifungal agents during intensive chemotherapy in patients being treated for acute leukemia.
Prophylaxis treatment was administered during intensive chemotherapy in children with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) from January 1, 2010 to December 31, 2012. Oral ciprofloxacin (at a dose of 300 mg/m2/12 hours) was administered after chemotherapy when a patient with AML or ALL became neutropenic and > 7 days of neutropenia was expected. Voriconazole (at a dose of 4 mg/kg/12 hours) was initiated at the onset of neutropenia in patients with AML and after 7 days of neutropenia in patients with ALL. Micafungin (at a dose of 2 mg/kg/day) was substituted for voriconazole when patients with ALL received vincristine. Prophylaxis treatment was discontinued when the absolute neutrophil count recovered to > 100/μL. All episodes of bloodstream infection, IFI, febrile neutropenia, and intensive care unit stays related to severe infection occurring between January 1, 2005 and December 31, 2012 were recorded.
During the preprophylaxis period, 62 children with ALL and 24 children with AML experienced a total of 44 episodes of bloodstream infection and 22 episodes of IFI. Seven patients died of severe infection. In contrast, in the prophylaxis period, 10 episodes of bloodstream infection occurred and no IFIs were reported to occur in 51 patients with ALL and 14 patients with AML. Moreover, no patient died of severe infection. Episodes of febrile neutropenia and intensive care unit stay were significantly reduced during the prophylaxis period.
Prophylaxis with ciprofloxacin and voriconazole or micafungin was found to reduce the rates of bloodstream infection and IFI in children with acute leukemia undergoing intensive chemotherapy. Cancer 2014;120:1255–1262. © 2014 American Cancer Society.